ROLE OF PCTS IN COMMISSIONING

  PCTs are now able to devise sound commissioning proposals for dentistry. Their dental services are now incorporated into general NHS planning.

NO. OF DENTISTS AND PATIENTS REGISTERED

  In respect of private sector dentists, and the number of patients registering with them, the view of the Patients Association is that we have seen a significant number of NHS and private dentists who are now offering private care.

  The reasons for this are not only increased fees available privately, but the uncertainty over the renewal of the contract in 2009. In turn this is because of problems in achieving UDA's and whether or not a new contract will be forthcoming in 2009. Dentists are increasing their percentage of private work to ensure the viability of their practice. The contract with the PCT cannot be re-negotiated or alternatively if they are negotiated it will be on terms that affect the viability of their practice.

  Patients have been grossly misled as to the availability of NHS dentistry. Media coverage of lack of dentists, confusion over the new contract terms, and the usual lack of information to patients about changes have led to a generalized view that there is no point in trying to access an NHS dentist.

  This has not been helped by the fact that dentists are allowed to do far more private treatment alongside the NHS treatment than they used to do. A number of treatments available under the NHS can now be offered privately without there being a conflict with NHS care, and therefore patients are being offered private treatment (and accepting it) whereas under the old rules, the mixing of private and NHS treatment was far more difficult. This former point of principle may have ramifications for other NHS funding.

  This acceptance of patients having private treatment makes the conversion of an NHS patient to a private patient much easier, and puts the NHS patient in a mindset where they feel that part of the treatment is not available under the NHS scheme. They feel they are being converted to private patients by a back door approach.

THE WORK OF ALLIED PROFESSIONS

  In respect of the work of allied professions patients need assurance of the competence of technicians, providing dentures, traditionally the preserve of dentists, as they move to offering more complex forms of treatment. Patients will need the assurance that conditions which the technicians work under are of the same standard as dental surgeries ie problems with sterility, and appropriate clinical vetting.

PATIENTS ACCESS

  In respect of patients access to NHS dental care, the Patients Association has had a number of calls to their helpline relating to the difficulty of obtaining NHS dental treatment in three specific areas:

1.  Postcode lottery

2.  Specific treatments—orthodontics, root canal. The contract has excluded care by stealth.

3.  Uncertainty over charges leading to a patient withdrawing from dental care all together.

PREVENTATIVE CARE AND ADVICE

  If the contract does not allow for time for preventative care and advice there is a real danger of higher cost to patients, clinically and financially in the longer term. The dentist remains the main point of advice on oral health.

DENTISTS WORKLOAD AND INCOMES AND THE RECRUITMENT AND RETENTION OF NHS DENTAL PRACTITIONERS

  Unless dentistry is a financially attractive proposition it follows that there will be a shortage of NHS dentists from Britain or overseas. Without ring fenced funding PCTs will be unable to deliver the dental service required.

  The public health responsibility of PCTs is made more difficult because of the variations in fluoridation levels of the water supply. This means in effect that the demands on PCT budgets varies according to the level of dental caries in their populations which directly relates to the level of fluoride in their local water supply. The Water Act 2003 gave the right to decide on water fluoridations in local communities. This variation in dental health is another example of the postcode lottery for health generally.

Patients Association

19 December 2007