Background to NHS Dentistry
Background
In the past two years, Labour has:
• Invested an extra £250 million in dentistry
• Recruited the equivalent of an extra 1,459 whole time dentists
• Announced the opening of a new dental school
• Funded an additional 170 training places per year in dental schools.
From April 1 2006, the NHS will implement reforms which will provide new contracts for dentists, a simpler system of dental charges and move commissioning dental services to a local level. These changes will provide a good deal for patients and a good deal for dentists.
A good deal for patients
• A simpler charging system. We are scrapping the current system of charges for dental treatments, which is complex and confusing. Instead of over 400 separate charges, we’re introducing three clear bands: band 1 (£15.50) for a preventative course of treatment (which might include an examination, a scale and polish and x-ray and preventative advice); band 2 (£42.40) for dental interventions (fillings or restorative treatment; band 3 (£189.00) complex treatments including dental appliances.
The maximum charge for NHS dental treatment of £189, is a reduction from the current maximum of £384. Those patients who are currently exempt from charges will continue to be exempt under the new arrangement.
• Patient-focused treatment and care. The new arrangements will move dental care away from the “drill and fill” treadmill towards a greater focus on oral health hygiene and preventative care. The new contracts reflect expert guidance from the independent National Institute of Health and Clinical Excellence, which recommends that patients attend their dentist at intervals based on their individual oral health needs, rather than the traditional check-up every 6 months. Patients with good oral health, following assessment with their dentist may not have to attend as regularly.
• Greater access to a NHS dentist. We believe that over time the reforms will help ensure that it is easier to find an NHS dentist. New ways of working based on the NICE guidelines should enable a greater number of patients to be seen.
Under the current arrangements, if a dentist decides to leave the NHS, the money allocated leaves the local area and returns to Whitehall. From 1 April, if a dentist leaves the NHS, the Primary Care Trust in the area will keep the money and use it to commission NHS dental services from other contractors.
It is our view that the vast majority of dentists will sign up for the new contract. However, a number of dentists and corporate organisations have said that they would like to expand their NHS work if other dentists in the area do not want to sign up. There are also some 1000 overseas dentists currently going through the International Qualifying Examination. We are therefore confident that the new contract, combined with other reforms and the additional investment by Labour will increase capacity and access to NHS dentists for patients.
A good deal for dentists:
• Under the new contract, a dentist who commits a high proportion of their work to the NHS, can expect to earn on average £80,000 per year, with extra money on top of this for practice expenses.
• This remuneration is guaranteed for three years, along with a 5% reduction in the courses of treatment that NHS dentists are expected to carry out
• We also believe that the move away from a “drill and fill” treadmill and a greater emphasis on preventative and fewer individual interventions are likely to reduce practice expenses and therefore increase net income.
Accusations and rebuttals
There is some misleading information being distributed. Below are some of the accusations being made and rebuttals.
Accusation: Regular patients will no longer be allowed to register with their dentists.
Rebuttal: Dentists will accept patients for treatment in the same way as now. The main difference is that at the moment there is a fixed registration period of 15 months for adults, in other words your registration lapses if you do not attend at least once every 15 months, although in practice many dentists recall patients for six-monthly check-ups. Under the new arrangements, there will be a more flexible approach. Instead of a fixed registration period, patients will agree with their dentist how often they need to attend, based on their oral health needs. But we expect dentists to keep lists of patients so that patients know who their dentist is, and vice-versa.
Accusation: Patients will pay more for dental work under the new charges
Rebuttal: This is not the case. Under the new charging system, there will be a single charge for a whole course of treatment, rather than separate charges for each individual item. It is misleading to make comparisons based on the current charge for a single filling. The charge for a course of treatment that includes items such as fillings will be £42.40, but this includes all the treatment provided within the course, together with the initial examination, diagnosis (e.g. x-rays), oral health advice and (if necessary) a scale and polish.
Under the new system the maximum charge anyone will pay for NHS treatment is £189, a reduction from the current maximum of £384. Those patients who are exempt from NHS charges will continue to be exempt under the new arrangements.
Accusation: Patients who look after their teeth will subsidise those patients who neglect their oral hygiene
Rebuttal: The new contracts reflect expert guidance from the National Institute of Health and Clinical Excellence, which recommends that patients attend at intervals based on their individual oral health needs, rather than a rigid requirement to attend every six months. Patients with good oral health will not need to attend the dentist as often.
A patient who attends every six months and receives just a check-up and scale and polish currently pays an average of £30.08 each year. In future, patients with good oral health are unlikely to have to attend more than once a year. If they have an annual course of treatment that includes examination, diagnosis, oral health advice and (if necessary) scale and polish, this will cost just £15.50.
Accusation: There will be an end to emergency and out-of-hours care for NHS dentistry
Rebuttal: Primary Care Trusts will be responsible for arranging emergency care. The Primary Care Trust will ensure that members of the public have access to urgent dental care when they need it. This does not necessarily mean paying for each individual dental practice to provide out-of-hours care as PCTs will have flexibility to develop arrangements that are efficient and responsive to patients’ needs.
Accusation : The new arrangements encourage dentists to have NHS patients for children only, while the children’s parents are required to register privately
Rebuttal: Under the new regulations, dentists will no longer be able to accept children as NHS patients on condition that their parents agree to private treatment.
Where a dentist is currently treating children only under the NHS, it will be for the PCT to decide whether to allow this to continue.
Accusation: The new arrangements were imposed upon a dental profession which was not consulted
Rebuttal: This is not the case. The new arrangements were discussed extensively with the British Dental Association. They are also closely based on learning from PDS pilots. What has been seen is that the numbers of items of service provided fall significantly under PDS – in the region of 25 – 30 per cent for an average course of treatment – and this has been built into the new arrangements. The new contract arrangement monitors courses of treatment, rather than individual items of service; and this should free up time to enable dentists to adopt a more preventative approach.
Rosie Winterton MP has invited the BDA to form an implementation group. The purpose of the group will be for dentists, patients, the Department of Health and NHS representatives to monitor the impact of the reforms and to ensure that the intended benefits for both dentists and patients are realised. However, to date, the BDA have not agreed to this.