Dental Tribune United Kingdom Edition

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Proven against bacteria and viruses in trials. • Keeps skin dry & hydrated • Free from allergic substances • Economical and easy to apply • New unique formulation About the author Neel Kothari qualified as a den- tist from Bristol University Dental School in 2005, and currently works in Cambridge as an associate within the NHS. He has com- pleted a year-long postgraduate certifi- cate in implantology at UCL’s Eastman Dental Institute, and regularly attends postgraduate courses to keep up-to-date with current best practice. United Kingdom Edition February 7-13, 2011United Kingdom Edition T he seemingly endless cycle of re-organisation, uprooting and change has now culminated in a new set of dental pilots due to be unravelled by the coalition gov- ernment in April. These pilots are aimed at testing a range of different models to gradu- ally move away from the UDA- based system towards a system based on capitation and a qual- ity and outcomes framework. Much of the rhetoric surround- ing this change sounds similar to that proposed when the 2006 dental contract was first sug- gested with once again an em- phasis of movement away from a treatment based system to a more preventative based one. Essentially these pilots will be based on a capitation system where dentists will be paid on how many patients they look after and the healthcare out- comes they achieve, rather than just the amount of treatment they provide. However with the country in economic strife and goodwill with the profes- sion virtually extinct, one must question whether this new set of pilots will work with the pro- fession to bring change or once again impose reform without the informed consent or will of its members. Of course, until the pilots reach their more conclusive stages, I certainly cannot say that I am against the prospect of piloting and, just like the 2006 contract, many of the aims pro- posed by the government reso- nate strongly with the profes- sion, none more so than one of the Department of Health’s (DH) overall priorities for the NHS, which is to cut bureaucracy and improve efficiency. With many practitioners, including myself, currently dealing with the rig- marole of the CQC and compli- ance with HTM01-05 I certainly welcome any plans to lessen bureaucracy, but more impor- tantly if we are to learn from the mistakes of 2006 surely the profession needs a greater say in how best to move forwards. An example of how the coali- tion government in my opinion can do better is by looking at the issues surrounding HTM 01- 05. On behalf of the profession, the British Dental Association (BDA) has repeatedly requested an evidence based evaluation of the HTM 01-05 proposals via NICE prior to their bureaucratic implementation and as yet it does not seem that this is likely to happen. If the DH wishes to restore goodwill with the profes- sion and is serious about reduc- ing bureaucracy, why not start by asking whether all aspects of HTM01-05 are really necessary and based on sound evidence? The initial set of pilots look at testing three simultaneous models, where, unlike the cur- rent system, dentists do not have to carry out a specified number of UDA’s but are instead paid based on the number of patients they see. The type 1 pilots aim to establish a fair baseline capi- tation value by looking at the way dentists carry out treatment without the financial incentives of providing UDAs. The type 2 pilots aim to test the implica- tions of a national weighted capitation model based on age, gender and social deprivation, where dentists will also be eligi- ble for payment against the QOF. In the final type 3 pilots the den- tal budget will be split, the capi- tation payment covering only basic care and a separate budget catering for complex care that involves dental laboratory work. Currently the Department of Health intends to run between 50 and 60 pilot sites which will be assessed after an initial pe- riod of one year, with scope to extend them until the new con- tract is ready in its final form where they are successful. The Department says that changes to the patient charge system re- quired by the new contract will require changes to legislation, a process which will take time and is subject to Parliamentary approval. It is anticipated by the DH that a new contract will be ready by April 2014. Clearly dentistry differs from other as- pects of the NHS by having a patient charge. Whilst many pa- tients are used to paying a fee for NHS dentistry, the government still adds more than £2bn a year in England to support NHS dentistry, so even though the service continues on under the umbrella of the ‘NHS’, for most people it cannot be said that it is free at the point of delivery. Whether we like to admit it or not, operating under a fixed budget clearly involves a level of rationing and, with due respect to the taxpayer, this is not an un- reasonable expectation. Under the current system, whilst the payments to dentists are rough- ly based on pre-2006 values, the burden of responsibility for high risk patients requiring advanced dentistry seems to be unfairly distributed, introducing what the coalition government calls ‘perverse incentives’. Whilst we can have various discussions on essentially how dentists should get paid, the elephant in the room is an open discussion on what NHS dentistry should re- ally provide, how much they should provide and to whom? After all, advanced treatment in dentistry is not just a highly complex, skilled activity, but an expensive one too. In an article for the BBC, Pro- fessor Jimmy Steele makes the point that if taxpayers are con- tributing to the NHS to provide costly and difficult treatment, asking the patient to provide a healthy mouth first seems a rea- sonable deal, doesn’t it? Profes- sor Steele accepts that this does sound like a form of rationing, however unlike restricting liver transplants to those on the wag- on or by-passes to nicotine quit- ters which involve chemically addictive processes, he draws a clear contrast that cleaning teeth properly usually requires little more than a few short and sensible conversations with a professional, a toothbrush and some toothpaste. It appears that any changes to the current system are still far away, at the earliest April 2014. The widespread criticism of the lack of piloting prior to the in- troduction of the 2006 contract seems to be being addressed by the coalition government, but af- ter the farce of 2006 it is difficult to know whether the profession will welcome these changes with open arms or merely see this as another upheaval too far. It is unlikely that many of the 2000 or so dentists who left the NHS in 2006 will come back and it is even harder to envisage how the profession would cope if the new new dental contract resulted in a further cull of den- tists away from the NHS. DT How do we pay for NHS dentistry? Neel Kothari discusses piloting and the new contract