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Dental Tribune United Kingdom Edition

page 11DTß Terrible statistics Dr Kilcoyne continued: “I was really pleased the programme directors left in my comments about the terrible statistics which show the third commonest rea- son for any child being in hos- pital, for any medical reason, is rotten teeth.” “There is simply no credible National Dental Prevention Strat- egy in England, the Department of Health in England has over- seen this neglect and some may even query if this is one of the worst cases of Mass child-abuse for such a vulnerable group! Surely we need urgent action now, education and prevention from birth, not yet more excuses, delays and blame-shifting from a docile Department of Health, otherwise children being born to- day in England are doomed to a similar miserable, but avoidable hospitalisation in the next three to five years too!” When asked what the Depart- ment of Health and Ministers in England should do now before the upcoming dental pilots even begin, Dr Kilcoyne said: “Like the economic crisis caused by a lack of proper focus and prevention in banking, the Government had to admit the truth, it simply couldn’t fund everything as before, priori- tisation and changes needed to be introduced to improve the situa- tion overall etc. Well, we need that same honesty dialogue with the public too, such that NHS den- tistry simply cannot provide for everyone’s clinical needs without limits and due to the economic climate, more funding is unlikely. I then think prevention needs to be a high-priority as the Depart- ment of Health in England puts together its first National Preven- tion plan, focussing on children from birth. Too much to ask? Dr Kilcoyne added: “Thus whilst the dental profession cannot avoid some public criticism for the sorry state of the NHS den- tistry system in England, we must now use Dispatches as a catalyst to demand that the Department of Health produce something that is properly fit for purpose in the public interest, focussed on pre- vention in the widest sense and prioritised to protect the most vulnerable in society - is that re- ally too much to ask? Professor of Primary Dental Care at King’s College London Dental Institute Prof Stephen Dunne, who was featured in the programme discussing the type of dental disease he was treating in the hospital environment, said: “I agreed (with much trepidation) to take part in the programme to try to inform the Dispatches team and to encourage a more bal- anced programme than I feared might be the case without my contribution. I spent several hours recording with the Dis- patches team and gave a full ac- count of the advantages and limi- tations of the previous ‘Fee per Item’ contract, the ‘New’ contract and the proposals for the future NHS contract. I also expressed my views on Dental Bodies Cor- porate and concerns about the future funding of NHS dentistry. What you saw and heard was what remained of my recording! However, the write up by Sam Lister in The Times on Saturday (despite the mis-quotation), the Dispatches website article and the television programme were, I believe, more balanced after my input than they would otherwise have been. I would, naturally, have preferred that more of my comments had been included. Undercover element “The programme was, of course, sensational and biased against dentists since this is what is thought to attract audiences. The undercover element was under- hand but is routinely used in in- vestigative journalism. The den- tists recorded were ‘bending the rules’ but the dentist pronouncing on their conduct could have been more balanced and discussed the role of the NHS contract in en- couraging such behaviour. “Feedback from colleagues is that [the programme] was unbal- anced but not to the extent that they expected. Feedback on my contribution has been generally favourable, in that it was consid- ered professional, provided some balance and that the content was truthful and accurate. I have re- ceived no direct feedback on the programme from patients but I have been inundated with re- quests for my help from patients experiencing dental problems! I understand that feedback from my students on my contribution has been favourable and much discussed on Facebook (appar- ently) but they expressed concern that the programme provided an unbalanced view.” Having watched the pro- gramme, dentist Ian Gordon said: “It is often uncomfortable for a profession to be subjected to journalistic scrutiny. It takes real courage to be interviewed for a programme such as Dispatches, there is always the risk of being misquoted and misrepresented. “Overall I feel the programme was balanced informative and re- vealed nothing more than what I would have expected. My only criticism of the dentists who were interviewed would be reserved for Dr Anthony Halperin, the expert witness, who dismissed molar RCT as a simple procedure. This was unfair and disingenuous. Dentists can make RCT straight- forward with years of experience and with use of additional equip- ment, but it is always a proce- dure with uncertain outcomes even in the most expert of hands. “The programme highlight- ed the enormous difficulty of offering private treatment to NHS patients especially for RCT and perio. Most dentists would agree that these items of treatment can be provided to a higher standard if provided privately - after all both attract zero UDAs.” Reputation He added: “There is simply no funding in nGDS for a scale and polish over the funding the practice receives anyway for an exam... similarly there is no fund- ing for RCT over and above the funding received for the final fill- ing needed after RCT. However, contractually these items should be offered as a NHS treatment and the clumsy way some of the dentists attempted to “sell” pri- vate treatment did nothing for the reputation of themselves or the profession. “Dispatches could have ex- posed more issues than they did. Had they sent a moderate needs patient with perhaps two or three failing crowns and a broken fill- ing or two and a loose CoCr den- ture round practices for treatment planning - the various treatment plans obtained and the reason for the prescribed treatment would have been interesting to see.” DrGordoncontinued:“In2006 I founded CHALLENGE along with Eddie Crouch and John Ren- shaw. We campaigned against nGDS and predicted all the out- comes that we now know blight the dental service. Deskilling, supervised neglect, gaming, PCT inflexibility... it was all obvious. “I suggested at LDC confer- ence in 2008 that extractions had increased and root fill- ings decreased. At the time the CDO challenged this and said there was no evidence of is trend. Yet Dispatches quotes a 34 per cent increase in extractions. In a civilised country where dental health is supposed to be improv- ing this is a horrific statistic. “Of course there were issues but these were policed by data monitoring, we have a far greater problem with under treatment and lack of prevention than we ever had with over treat- ment before. As a profession we have to do something NOW. Change on horizon “The CDO sometimes seemingly singlehandedly supported nGDS right up to the point when the Coalition criticised the contract, with good reason, for all its fail- ings. He listened but never acted to improve the contract and in- deed as PCTs evolved they have become less flexible and more difficult in their dealings with dentists. Clearly he now sup- ports proposals for pilots and we all welcome that change is on the horizon. “However change is at least three years away, three years of the same contract, UDA and tar- gets. By the time the next contract starts we will have had eight years of nGDS, four under Labour and four under the Coalition. Surely now they are committed to abo- lition of the UDA they must do something to relax targets and address some of the negative perverse incentives of the con- tract, some of the incentives dis- patches identified. “So whilst the BDA must con- tinue to work with the DH on the pilots they must not forget this is 62 practices out of 10,000. They must push for target relaxation now, and if achieved the profes- sion must improve its image by delivering the care patients need. Easier said than done but with- out a change in the contract and support from the DH nothing will change.” Another dentist, Simon Thackeray, said: “I think it’s about time the gaming was exposed. The title of the programme was unfair, but other than that the gaming was dealt with very well. This is more rife than many are prepared to admit. Aggressive stance “I feel that those who are providing for example scales privately rather than on the NHS should not have signed the new contract. You cannot have your cake and eat it, and I feel the PCTs should have taken a more aggressive stance in the past to stamp out this gaming. I hope now that this is stamped out, and the practices that are doing this realise that instead of hiding behind the lack of knowledge of the public, they become open and honest about who is funding the treatment and how. He added: “I am also concerned that the concept of full lists is being used to stop patients accessing the serv- ice. There is no registration, so no concept of having a full list. If a patient needs a den- tist the contract obliges you to take them on as a patient. This fact alone is the reason why I refused to sign the contract and converted in 2005. But that’s for another day and an- other Dispatches programme probably.” DT June 6-12, 201112 News & Opinions United Kingdom Edition ‘The programme was, of course, sensational and biased against dentists since this is what is thought to attract audiences’ Dentists are still faced with enourmous difficulty when it comes to providing treatment for NHS patients