Dental Tribune United Kingdom Edition

February 7-13, 2011United Kingdom Edition L ocal councils are to have a say in how NHS dental serv- ices are commissioned and run. Whilst primary and secondary dental services are to be commissioned by the NHS Commissioning Board, local authority councils will have the power to agree lo- cal strategies to bring the NHS, public health and social care together, and will have a lead role in integrating the com- missioning of services to meet the needs of the local population. Under the NHS Health and Social Care bill’s sweeping re- forms, announced by Health Secretary Andrew Lansley, lo- cal authority councils will share commissioning duties with GP consortia and the NHS Com- missioning Board through the establishment of health and wellbeing boards at every up- per tier authority from 2013, (although they could be operat- ing in shadow form as early as from 2012). Until now, local councils have only been involved in the provision of social care. A sep- arate new body, called Public Health England, will be created to improve public health and reduce health inequalities be- tween the richest and poorest. At the same time, the number of health Arm’s Length Bodies (ALBs) is to be reduced from 18 to between eight and 10. Or- ganisations which are no longer needed will be removed from the sector, with essential work moved to other bodies. ALBs fac- ing the chop include the Health Protection Agency, and the Na- tional Patient Safety Agency. The proposed reform of the NHS and the abolishment of Primary Care Trusts has been met with skepticism and mixed reactions in a wide range of stakeholder groups. There is widespread concern that there will not be enough dental ex- pertise amongst board members involved in the commissioning of dental services, and a lack of thorough knowledge of how dental practices are run. In the proposed structure, the chan- nels of responsibility are opaque and confusing, and there are question marks of where ac- countability will lie. Dr Susie Sanderson, the Brit- ish Dental Association’s Execu- tive Board Chair, has said that: “There will clearly need to be an involvement of experts such as consultants in dental public health, dental practice advis- ers and local dental committees to ensure that patients’ needs are addressed as services are commissioned.” According to Paul Burstow, Minister of State for Care Serv- ices, local authorities will have the power to require informa- tion and attendance at scrutiny meetings of any provider that is funded by the NHS. This in- cludes the scrutiny of GP prac- tices, dentists, pharmacies, and independent and voluntary sec- tor providers. An NHS dentist from South East London, who does not wish to be named, has said that Councils “will not be perceived as having enough knowledge or expertise in the dentistry arena to be able to pass judgment on healthcare professionals. High street general dentistry is still mainly delivered by independ- ent practices, run by principal dentists as small businesses, and it is likely that they will not be happy having pen pushers from the Council calling the shots.” The BDA has also pointed out that until now the coalition government has failed to ad- dress a number of important issues for dentists and their patients, leaving many ques- tions unanswered. Importantly, these include the Government’s intentions for how dental pub- lic health fits into the envisaged arrangements and arrange- ments for care for vulnerable patient groups. Dr Sanderson has said that: “This Bill must answer those questions.” While the exact details of the relationships between the NHS Commissioning Board, GP consortia and local council authorities are still to be clari- fied, a spokesperson for the Department of Health has said that: “The NHS Commission- ing Board will commission both hospital and primary dental care services to ensure integrated dental services.” However, the Department of Health has not revealed what extra funding, if any, Councils are to receive in order to be able to meet their new obligations under the new bill. It is also unclear how much budget has been allocated for the commis- sioning of dental services. The NHS reforms come at the same time that a new gen- eral dental practitioner contract is being drafted. Last December the Department of Health an- nounced that pilots will begin this April and will test new con- tract models that focus on pro- viding continuing care for reg- istered patients and improving access. They will also explore ways of moving away from the target-driven basis of the cur- rent dental contract and instead focus on prevention and qual- ity of care. The new contract is due to be published in 2014; however, dental groups have ex- pressed concern over the timing of the NHS reform and are wor- ried that energies will be divert- ed into implementing the new commissioning process rather than on securing a good deal for dentists and patients. Lord Colwyn, Vice-Chair of the All-Party Group for Den- tistry, has highlighted that in 2005 a new dental contract was introduced at the same time as PCTs were reorganised and that during the restructuring many dental leads and commis- sioners were not in post to over- see the implementation of the new contract. The NHS reforms pose ques- tions such as what criteria will the local authority council be measuring, and to what level will they be able to scrutinise? What happens if a council deems a practice not perform- ing adequately? Who will moni- tor practices, and will they be qualified? Such issues will re- main unanswered for some time while the new structures set out in the new bill are hammered out. One thing is clear, and that is that change is coming and that practices are going to have to adapt quickly. DT Change is coming... Dental Tribune’s Maria Anguita takes a closer look at the recently published Health and Social Care Bill ‘The proposed reform of the NHS and the abolishment of Primary Care Trusts has been met with skepticism and mixed reactions in a wide range of stake- holder groups.’