1.  The role of Primary Care Trusts in Commissioning Dental Services

—  Western Cheshire Primary Care Trust had worked closely with its Dental Contractors in the years leading up to the new contract. Most of the major service providers had been working under Personal Dental Service Contracts following the principles established in the Ellesmere Port Pilot in 1999. There was therefore an established team with a clear understanding with regard to how dental services worked. The contractors had been working with the Primary Care Trust for two years to achieve the objectives which would meet patient needs around access and quality of service.

2.  Numbers of NHS dentists and numbers of patients registered with them

—  As detailed above the work carried out prior to the new contract identified any areas where dental services were at risk including those from practices intending to "privatise" rather than accept the new contract. The PCT was therefore able to anticipate any problem and investigate situations prior to them occurring. The result was that any withdrawals from the NHS were rapidly met by practitioners who had already identified their willingness to expand. The Primary Care Trust therefore was able to contract for more service than the previous year contracting with an increased number of whole time equivalent dentists. Dental Practice Board statistics identified that 84% of children and 65% of adults living within Primary Care Trust boundaries were treated during the year 06/07 confirming services had been maintained.

3.  The number of private sector dentists and the number of patients registered with them

—  The private sector has remained much as it was prior to the new contract. The majority who treat adults privately but requested children only contracts have been accommodated but with contracts restricted to 12 months. These contracts will be expected to reduce annually as an increasing number of patients take advantage of the access available in our practices.

—  The Primary Care Trust's aim is to ensure that patients are not forced to accept private treatment due to a lack of NHS provision. It is confident that all its residents can be found an NHS dentist when they need treatment.

4.  The work of allied professions

—  In order to take full advantage of the benefits of team working it is necessary to have the benefits of a larger scale operation. The Primary Care Trust has encouraged practices to expand to ensure that they will be of a size to take advantage of Professions Complimentary to Dentistry. Several projects are being promoted using capital grants to assist practices to achieve the required growth and become training practices of the future.

5.  Patients access to NHS dental care

—  The UDA rate is crucial to the successful commissioning of dental services. The Primary Care Trust entered into negotiations with practitioners on the basis that the UDA payment rates agreed would be at a level fair to the practice and to the Primary Care Trust's responsibility to provide access. The result has been guaranteed access for any resident of the Primary Care Trust.

—  Access for fee paying adults has an additional affect on patient charges. Low access means low Patient Charges, good access means high Patient Charges. Access and Patient Charges are therefore closely linked and a high UDA rate results in less activity and therefore less access it will be the fee paying adults who miss out and the Primary Care Trust left with Patient Charge shortfall.

6.  The quality of care provided to patients

—  The Primary Care Trust took part in the pilot scheme of Dental Reference Officer visits which confirmed the high standards being met by practices. This is partly as a consequence of the established Peer Review Groups led by the Primary Care Trust dental adviser over several years. The patients' survey carried out at the end of the 1st year confirms the patient's positive view of the services being provided.

7.  The extent to which dentists are encouraged to provide preventative care and advice

—  The Primary Care Trust has now established a new Oral Health Plan, and will be working with contractors through the Peer Review Groups to implement Primary Care Trust policy. Only one contractor has a GDS contract and the rest work under a PDS contract which will ensure they work with the Primary Care Trust to implement the Oral Health Plan.

8.  Dentists' workloads and incomes

—  The Primary Care Trust does not have information on these areas but there is little evidence that they have either received any additional bonus in either increased income or a reduced workload.

—  This is implicit in good contracting to ensure the same levels of activity are maintained and that benefits are only achieved by working differently.

9.  The recruitment and retention of NHS dental practitioners

—  The Primary Care Trust has not noticed any real change in the movement of dental personnel. Despite the challenging UDA rates the contractors have been able to recruit to posts when they have become vacant.

IN CONCLUSION

  Western Cheshire Primary Care Trust has found the last three years to be very challenging with regard to implementing the new contract. It has benefited from keeping together an experienced dental team who have been able to commission services in a robust but fair manner. This has benefited the Primary Care Trust, the practitioners and most importantly the patients.

  It is now moving forward with its contractors to develop dental services to meet the requirements of its population and to ensure that access for dental care is available for all.