Changes to dentists’ contracts will make it easier for patients to find an NHS dental surgery, the UK Health Secretary has promised.
NHS Dentists are no longer to be rewarded primarily for the number of fillings they carry out.
Dental Practitioners will instead have a bigger chunk of their dentist salary decided on the number of patients they have, and serve. “Quality” and “prevention”, rather than quantity of treatments, are the new buzzwords.
The reforms, outlined in an independent review chaired by Professor Jimmy Steele, were immediately accepted “in principle” by the health secretary.
The Professor said that fewer visits are the key aim. Dental Health and prevention rather than cure must be the primary aims.
NHS Dentistry is a hot topic once again with a general election looming. From the public’s perspective they have real difficulty finding an NHS Dentist who will take them on. Once they have found one, many are not entirely happy with the care due to the fact they feel any work they have done may be below the levels of private work.
It’s unfair to heap all the blame on the dental community. Decades of underfunding by successive governments have left NHS Dentistry in trouble. It is also fair comment to say the financial incentives have not been properly structured and have left opportunity for criticism of dental professionals.
The Tories have promised, if elected, to bring another one million UK NHS Dental patients back into the NHS fold, and to have a dedicated NHS Dentist.
Professor Steele’s view is that:
“Over the last 60 years, dental services have been about quantity, about delivering fillings, We need to move away and move on to quality – to accept that less is actually better.”
“Value for money is not about more at a lower price; value for money is not having to do it all. Dentists should take responsibility for some of the things they deliver. We should provide restorative work to last. Patients should not have to pay for substandard treatment.”
Asked how often patients should see a dentist, he said that :
Some , depending on the state of their teeth , need go no more than once every two years.
The idea of six-monthly check-ups was outmoded. Longer recall intervals are a marker of success, not an abdication of duty.
Prof Steele said he hoped more private dentists would be attracted to sign contracts with the NHS under the terms of the newly proposed financial rewards.
The Secretary of State for Health, Andy Burnham, gave an enthusiastic endorsement to the proposals, declaring: “I recognise that this is an area of unfinished business where we need to ensure that NHS dentistry is on the right path.”
Access to NHS dentists had been improving recently, he maintained. A recent Which? magazine report said that nine out of 10 people searching for NHS dental treatment had been successful in the last two years. The new reforms, he added, “are going to provide NHS dentists for everyone who wants one.”
“From this autumn, selected dental practices will pilot some of the independent review team’s recommendations including linking a significant part of dentists’ income to the number of NHS patients registered with them, not just the number of treatments they provide.” More than one model of financial incentives might be trialed to see which was the most effective.
To make it easier to register with a dentist, patients will in future be able to call NHS Direct or check the NHS Choices website for information on local services, he said. Extending water fluoridation would also be a priority to protect, in particular, children’s teeth.
The review observed that under the current contract “there are limited incentives for dentists to … take on new patients”.
The British Dental Association welcomed the review as a move away from unpopular targets that had distorted health service provision. It stressed that the reforms should, unlike previous changes, be piloted carefully to ensure that they are practicable.
John Milne, chair of the BDA’s general dental practitioners committee, said: “We have an opportunity to learn from the difficulties of 2006. The report’s recommendations appear to be far-reaching. They describe a new approach … I hope it will mean a move away from the targets-driven arrangement that is currently in place.”
Critics have blamed dentists for exploiting the system by breaking down simple treatments into multiple sessions known as “units of dental activity” (UDA), each one of which triggers a separate payment.
“We heard accounts from younger dentists that suggest the single-minded pursuit of UDAs can, and has, become ingrained in young practitioners to a worrying degree,” the review said. “Behaviour may be adopted that maximises the rate at which UDAs are achieved, often referred to as ‘gaming’.”