SUMMARY

  BASCD is an alliance of individuals with an interest in population oral health, working together to:

—  Provide a set of principles for the improvement of oral health and the development of oral health care and promote their dissemination.

—  Influence policy at international, national, regional and local level in support of oral health.

  Members work in dental public health, primary and hospital dental care (particularly community and special care dentistry) and beyond. Our evidence relates to the following four main areas:

I.  The role of Primary Care Trusts in commissioning dental services.

II.  Patients' access to NHS dental care.

III.  The quality of care provided to patients, which must involve prevention.

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

V.  Workforce issues.

  The Association has been involved directly or through its members in developing, and implementing, key guidance, in support of recent dental policy changes and the promotion of oral health particular, as outlined below.

THE ROLE OF PRIMARY CARE TRUSTS IN COMMISSIONING DENTAL SERVICES

  1.  Members of the Association play an important role within Primary Care Trusts [PCTs] and Strategic Health Authorities as advisors on commissioning of dental services. However, with recent management reorganisations there has been a significant reduction in service capacity. There are therefore serious pressures on the capacity of Dental Public Health specialists to deliver sufficient dental public health support to NHS organisations at a time when the expertise is clearly required to support the new commissioning powers of PCTs. The lack of Dental Public Health advice in some PCTS is a problem.

  2.  This reduction of capacity, in both the NHS and academia, has been recognised by the Department of Health. Within England there is currently a Review of Dental Public Health capacity and capability. This Association, welcomes this review and considers it vitally important that there should be sufficient specialist expertise at local and strategic levels to ensure that there is effective needs-led commissioning of dental care, both treatment and preventive.

  3.  In recognition that commissioning of dental care should relate to local need, members of this association have worked with Primary Care Contracting in developing a needs assessment toolkit to assist with assessing need at Primary Care Trust levels.[1] This is not a one-off process but requires work to inform commissioners on an ongoing basis on all aspects of oral and dental care. Members of BASCD have been involved in national events and workshops in shaping policy, commissioning and service redesign to support needs-led commissioning.

  4.  This Association through its Information Section has played, and continues to play, a major role in oral health surveillance through the coordination of local epidemiological surveys.[2] This includes quality assuring the programme. This information is important to inform needs-led commissioning as outlined above. In addition to local surveys, the comparative information on national trends from national surveys is vitally important. As an association we are concerned that the Adult Dental Health Survey for 2008 has not yet been commissioned. This would have been the third UK survey and the fourth decennial survey for England. We urge that this national survey takes place as soon as possible as it provides national and regional information on adult oral health in the population.

PATIENTS' ACCESS TO NHS DENTAL CARE

  5.  Access to dental care is an important public health issue for all sections of society. NICE dental recall guidance suggests that adults should attend at least once every two years and children every year, with more frequent checkups based on their level of risk[3]. Current levels of uptake of dental care are in the region of 70.7% for children and 50.5% for adults in England[4]; and thus while a proportion of adults attend for private dental care, there is still a significant section of the population who is not accessing care regularly (within a 24 month period). Many of these groups will require care to be provided in modern delivery systems as outlined by Lord Darzi[5], which involves the development of primary care centres with extended opening hours and outreach facilities.

  6.  It is particularly important to ensure that in a market based health economy, that vulnerable groups in society do not miss out on receiving dental care and thus result in an increase in inequalities in health. This is particularly important when many vulnerable groups in society, such as older people, are not exempt from patient charges in England. Furthermore, people with high oral health needs are not supported in receiving care under the new system. Members of the association have been involved in the recent guidance on Valuing People's Oral Health[6], which highlights the importance of promoting oral health in people with learning disabilities.

  7.  For many BASCD members their area of clinical practice is in special care dentistry. They face daily the challenges and complexities of providing dental care for this client group. For many such patients the complexity of needs, even to enable the simplest dentistry to be performed, is considerable. BASCD members have worked with representatives of the BDA Central Committee for Community and Public Health Dentistry to develop a model which describes such complexities. This model, known as the "casemix toolkit" is now beginning to be used in many salaried dental services throughout the country. The model, which will be formally launched in January 2008, enables both providers and commissioners to better understand these needs and provide appropriate services to meet them.

  8.  Individuals from this Association are also leading and contributing to a review of Black and Minority Ethnic populations in relation to primary dental care for the Department of Health. Collection of ethnicity data as part of routine primary dental care information systems will be important to support this initiative.

THE QUALITY OF CARE PROVIDED TO PATIENTS

  9.  The quality of care accessed is important. One feature of quality which this association supports proactively is health promotion as outlined by the range of activities in which the Association, or members of BASCD as individuals, have led or been involved in a range of important initiatives in support of Standards for Better Health.

  10.  Information on the nature of care provided and how this relates to oral health needs and risk of disease should be collected in future at practice level to provide an indication of the "appropriateness" and therefore "quality" of care.

  11.  Members of the Association have supported dentists with a special interest in Prison Dentistry to develop support networks and quality initiatives in support of oral healthcare amongst this needy section of the population[7].

THE EXTENT TO WHICH DENTISTS ARE ENCOURAGED TO PROVIDE PREVENTIVE CARE AND ADVICE

  12.  Working with the Department of Health and other key stakeholders, members of this association have assisted with the development of a range of health promotion initiatives which include:

—  Oral Health Promotion toolkit—Delivering Better Oral Health[8]

—  Tobacco cessation—Smokefree and Smiling[9]

  These are very important initiatives in supporting health promoting oral and dental care in line with contemporary evidence. The "toolkit" is currently being distributed to all dentists and requires a series of actions to support its implementation from education through to remuneration.

  13.  It is of great concern to this Association that there is nothing in the current dental contract to encourage dentists to provide preventive care and advice. A reorientation of dental services to promote oral health and prevent oral diseases in an evidence-based manner is the only way to play a major contribution to the public and patients in the long-term. In promoting this approach, the Association recognises the important work of Sir Derek Wanless[10,11], and the more recent work of Lord Darzi[5] which supports "staying healthy". This must be addressed in future dental policy. Members of BASCD are also working on a "Commissioning for Oral Health" self-assessment toolkit to support PCTs assess competence in this role and identify areas for improvement by describing and sharing excellence.

  14.  Prevention must not be limited to attendees of dental services but of necessity must focus on the whole population. Resources are therefore required to support public health programmes at population level.

WORKFORCE ISSUES

  15.  In considering the size of the dental workforce, merely considering numbers of dentists, and dentist to population ratios is not sufficient unless the "whole time equivalent" is considered. Such data are currently not available.

  16.  To date, the new contract does not seem to provide a direct incentive for the use of skill-mix to extend the workforce. In future there should be greater emphasis on team-working and skill-mix maximisation, as many of the tasks in primary dental care could be undertaken by hygienists and therapists working with dentists. Individuals from this society have contributed to workforce planning projects and a national toolkit resource[12].

Dr Liana Zoitopoulos

Secretary of BASCD

December 2007

REFERENCES

1.  Primary Care Contracting: Oral health needs assessment toolkit for primary care trusts. London: Primary Care Contracting; 2006

2.  BASCD: The Information Section [http://www.bascd.org/info_home.php]

3.  NICE: Dental recall guidelines. National Institute for Health and Clinical Excellence; 2004.

4.  The Information Centre: Primary dental care data, 30 July 2007 http://www.ic.nhs.uk/statistics-and-data-collections/primary-care/dentistry/nhs-dental-statistics-q1-2007-08

5.  Darzi A: Our NHS Our Future. London: Department of Health; 2007

6.  Department of Health: Valuing People's Oral Health: A good practice guide for improving the oral health of disabled children and adults. Department of Health; 2007

7.  Department of Health: Guidelines for the appointment of Dentists with Special Interests in Prison Dentistry. London: Department of Health; 2007

8.  Department of Health: Delivering better oral health: An evidence-based toolkit for prevention. London: Department of Health and British Association for the Study of Community Dentistry; 2007

9.  Department of Health: Smoke free and smiling. London: Department of Health; 2007

10.  Wanless, D: Securing good health for the whole population: final report. London: HMSO; 2004.

11.  Wanless, D: Securing our future health: taking a long-term view. London: HMSO; 2002.

12.  National Workforce Resource: National Workforce Projects: Dental Workforce Resource Pack. Manchester: NHS National Workforce Projects; 2007