The NHS Dental Contract Reform is a much debated and talked about topic in modern dentistry, with a mixture of emotions experienced amongst professionals. One of the many learning opportunities available at this year’s Dentistry Show enabled dental professionals from all areas of the industry to find out more and to get their questions answered.
The open discussion session was led in the GDP Theatre and led by Dr Ben Atkins, a Principal Dentist currently taking part in the NHS pilot scheme; Dr Roger Matthews, Chief Dental Officer of Denplan Ltd; Professor Jimmy Steel, Head of the School of Sciences at Newcastle University; Elizabeth Lynam, Head of Dentistry at the Department of Health (DoH); and Professor Liz Kay, Foundation dean at the Peninsula Dental School.
Ben Atkins opened the discussion by sharing his own experience of the pilot scheme and emphasising how much his practice had changed as a result. He also encouraged delegates to interact during the session, and to use this opportunity to pose any questions they had.
Next up was Jimmy Steel who has been involved with the review of the contract, and he opened with a bold statement – that with the right pathways in place, England could have the best oral health care system in the world. He said that with the highest trained and most committed dentists around the globe, and the current dental health statistics in the UK, this is more than possible.
The one major barrier at the moment is the existing contractual system, which doesn’t necessarily support the focus on improving oral health. He emphasised that the NHS contract reform aims to change this, with the concept of prevention to feature heavily. He also said that a lot had been learnt in the last two years of the pilot schemes, but that one area still being looked into is the management of patients requiring complex treatment.
Elizabeth Lynam took over the speaking at this point to provide a perspective from the DoH. She was keen to emphasise that this new scheme is not being created behind closed doors, and that the reason for the seemingly slow progress is that they want to be very thorough to ensure the best and most stable system possible is put in place. Elizabeth added that the DoH is working with the profession to find out what works, what doesn’t work and how the various aspects can be effectively monitored and measured.
Liz Kay then went on to give her opinions and concerns from the point of an epidemiologist – who studies the patterns of disease in the community. She warned delegates that the ‘average statistics’ used to demonstrate oral health, don’t necessarily give the full picture. For example, while two thirds of five-year-old children have good oral health, the other third in fact have three-four decayed teeth. Her main concern was to ensure the contract reform took into account the extremes as well as the average figures, in order to make sure the real problems were addressed.
The main section of the session was then concluded with Roger Matthews suggesting that the changes to the NHS contract will have a profound affect on the private sector, but perhaps not in the way originally thought. He said that he had seen little evidence of the ‘flood of NHS dentists going private’ initially predicted, but other changes were inevitable. As one of the most commonly known ‘brands’ in healthcare, a change to the NHS will change how dentistry is perceived by all, and practices will need to move with the cultural shift in order to provide an effective service.
The second part of the session then enabled delegates to voice their own concerns. The main worries from the floor included whether the new contract was likely to be changed at the last minute due to expense, to which Elizabeth responded that the thorough analysis at this stage of the pilots was to avoid this exact situation.
Other professionals also highlighted concerns about the proposed new care pathways and whether these would obstruct complex care from being provided to some patients. The panel seemed to be in agreement that while the care pathways would primarily encourage preventative treatment, practitioners will retain the control to deliver the care that is needed.
A particularly controversial point raised was regarding how dental associates would be paid in the new preventative-based system, and to this the panel responded that this is still being looked into. As this would also apply to extended-duty dental nurses and hygienists this was an important issue and delegates who felt strongly about this were encouraged to get involved with the pilot process in order to help form an effective solution.
Additional issues raised included the delicate line between prevention-based care and neglect, and whether the current UDA targets would remain in place. The idea that the demand for complex care will increase as the percentage of older patients continues to rise was also discussed and the panel were keen to highlight that all this was being taken into consideration for the contract reform.
A change for the better?
While there are clearly still areas that need refining within the contract reform, it seemed to many in this discussion that it is headed in the right direction. Until further pilots are completed, the profession will simply have to watch this space!
The Show returns to the NEC in Birmingham on 17th & 18th April 2015.