DENTAL SERVICES

The role of PCTs in commissioning dental services

  Primary Care Trusts (PCTs) often do not try to understand the working pattern of Dental Practices but try to impose their own management agenda. This is often because they do not have any Dental knowledge themselves.

  PCTs should have a Consultant in Dental Public Health to give them advice, but in Coventry there is no such person in post.

  PCT Officers often have the attitude that as long as Units of Dental Activity (UDAs) are delivered, they are not bothered how this activity is delivered.

  The new contract is failing the requirements of high needs patients.

  Commissioning mechanism is not transparent, as practices with General Dental Service and Orthodontic contracts were unfairly treated in not allowing for similar number of patients to be treated prior to the change.

  PCTs are often sitting on the money rather then spending it on patient care, in instances where a practice may not utilise its total UDA allocation.

  PCTs tend to assume that the work output will be uniform day in day out without recognising that patient through put can vary for any number of reasons.

  PCTs need to recognise that the quality of dental service provided has to be taken into consideration as well as some quantitative measurement, rather then penalising practices financially if they are not delivering the total UDAs.

  PCTs need to recognise that they are relying on the goodwill of dentists who have invested very heavily in their practices to deliver high quality of dental service.

  Orthodontic Service is suffering, as this service needs to be commissioned properly.

  There is no Consultant in Orthodontics support available.

Numbers of NHS dentists and the number of patients registered with them

  Under the new contract, dental patients are not registered with any practitioner.

  Previously dentists were paid a nominal fee for registering patients and the dentist was responsible for providing that patient continuing care as well as providing emergency care.

  Although the number of NHS dentists may have increased, the amount of work done has decreased.

  Number of dentists has been recruited from abroad. They are not familiar with the NHS system and therefore require further training in order to obtain Vocational Training number. Therefore the quality of service provided will be affected.

  Orthodontic dental services are also in chaos as practices, which previously could provide orthodontic service and still can provide NHS Orthodontic care are being forced to abandon patients because of their small orthodontic contract values. These practices are being asked to have waiting lists, where none existed before and if the circumstances are suitable there is still no need for waiting lists.

  In Coventry, we do not have a Consultant in Orthodontics and therefore no Consultant Orthodontic support available to General Dental Practitioners.

  Therefore patient needs cannot be adequately assessed.

Number of private sector dentists and the number of patients registered with them

  In Coventry about 15% of practices have gone private after the contract came into being. Therefore patients are being forced to receive private dental care, whereas before 1st April 2006, patients were able to obtain NHS treatment at these practices.

  Therefore there is a question mark as to whether access has improved or deteriorated.

The work of allied professions

  Under the NHS, very few Hygienists employed. The contract is not very conducive to employing Hygienists or Therapists.

Patients' access to NHS dental care

  In some areas of Coventry, access seems to have improved as dentists are advertising for dental patients.

  However there are other parts of Coventry where practices have gone private and therefore patients in those areas will have difficulty getting NHS dental care unless they are willing to travel.

  The way Dental Charges are levied tends to put patients off dental services as sometimes a patient may need only a small filling and they are having to pay a same charge as someone having ten fillings.

  PCTs also look at the dental charges as a way of increasing their revenues.

The quality of care provided to patients

  Under the new system, complex treatment needs are not being addressed. Some nervous patients would benefit from use of sedation techniques. However as these techniques are time consuming and require further training and investments, there is no incentive under the new contract to provide these services. Therefore quality of care provided has deteriorated.

  As mentioned earlier, orthodontic treatment is not easily available to patients and therefore quality of care has deteriorated. There is very little incentive to provide preventive dental care.

  Health gains and quality indicators or number of patients treatments satisfactorily completed should be measured rather then Units of Dental Activity.

  Dental activity should be to do with improvement in oral health of patients rather then just measuring fillings or extractions.

  General Dental Practitioners are better placed to look after patients rather then PCT administrators, as there numbers seems to be increasing all the time just to monitor statistics and create unnecessary paperwork. Therefore inspiring to improve quality of care is not present in the new contract.

  The requirement to come close to target is very difficult, as the treatments should not have to be tailored just to meet the right target.

The extent to which dentists are encouraged to provide preventive care and advice

  As mentioned earlier, there is very little incentive in the new contract to provide preventive care and advice. There should be incentives to reduce the decay experience of the public by use of oral health promotion techniques, fluoridation applications, and fissure sealant applications.

  If these encouragements take place then better use could be made of Hygienists and Therapists.

Dentists' workloads and incomes

  Dentists are highly trained professionals and they are best placed to deliver a high quality appropriate and effective dental care to the public. It seems fewer dentists are doing more work.

  If a dentist sets out to provide a high quality dental care to all his or her patients, the dentist may not achieve the targets set. Therefore the dentist is financially penalised which seems so unfair for a person who is trained to put the interests of his patient first.

  Dentists would like to be paid for providing higher quality of dental care.

  It is high time that PCTs should stop looking at treatments, which generate patient charge revenue only.

  Continuing education is very important for any professional person and therefore protected learning time should be there in reality rather then just on paper.

  Every Dental Practice should be provided with sufficient resources, so that all staff and dentists can be adequately remunerated and the patients can receive the dental care in the best safe environment.

  Under the new system, it is very difficult to set up a new practice. This would also reduce the choice for patients.

The recruitment and retention of NHS dental practitioners

  There is no recruitment of practitioners. If practitioners do not provide sufficient patient charge revenue, there is no security of employment. Recruitment is likely to decrease, as fewer newer practices will open.

  Vocational Training is inadequate under new contract and trainees get less experience compared to before April 2006. Trainees on completing their course cannot stay with same practice and therefore there is no continuing care relationships with patients.

  Retention of practitioners could be improved by providing facilities for postgraduate course participations.

W Sidhu BDS (Sheff) MCDH (Birm) DDPHRCS (Eng)

Honorary Secretary for Coventry LDC

December 2007