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As the media focuses the majority of its attention on the formation of GP consortia, has dental health care been overlooked? Beki Hill asks what the dissolution of the Primary Care Trusts and the creation of a National Commissioing Board will mean for dentistry.
She interviewed Barry Cockcroft, the Chief Dental Officer; Colette Bridgman, a consultant in public dental health in Manchester; Professor Jimmy Steele from Newcastle University; and Nigel Hill, a General Dental Practitioner in Greater Manchester.
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Transcript
Beki Hill: A lot of the debate surrounding NHS reforms has focussed on the creation of GO consortia. But how will the new Health and Social Care Bill, and the dissolution of the Primary Care Trusts or PCTS, affect dentistry and dental health care? I’m Beki Hill and I spoke to Barry Cockcroft, the Chief Dental Officer to ask what these changes will entail.
Barry Cockcroft: The part of the reforms that relate to dentist aim to deliver the coalition commitment. A lot of the detail will be contained in secondary legislation, but what is in the Bill is the moving of the commissioning of dental care from individual primary care trusts, which are going to be abolished in 2013 to the national commissioning board.
BH: But does the creation of a National commissioning board goes against the climate of decentralising medical health care elsewhere, and will this work at a local level? To find out I spoke to Colette Bridgman, who is a consultant in public dental health in Manchester.
Colette Bridgman: Many of the functions of commissioning can be carried out at a national level but I think what we could lose and what’s been very very important in moving forward for dentistry has been that local contact and that local link for general practices and I wouldn’t want to see that lost. There’s a very clear remit for some local input. I think this is the time for people looking for opportunities and wanting to hear – how could local structures work and sit underneath the national commissioning board?
BH: The British Dental Association, while offering some amendments to the Bill have been generally supportive of the reforms put forward, and Mr Cockcroft explained to me why there’s benefits across the board.
BC: Dentistry sits completely within the national commissioning board and the British Dental Association are absolutely supportive of that and I think it gives us the ability to produce an integrated dental service in the future which is absolutely fantastic. Previously the contract were held individually by PCTs they were very local contracts, and although that worked well in some areas there were other areas it didn’t, and what moving it all to the commissioning board does is give us an opportunity to bring consistency to dental contracting whilst at the same time enabling us to incorporate local flexibility to meet local needs. So it’s almost the best of both worlds.
BH: Something that hasn’t really been discussed much though is the fact that dental health care was being reformed well before. Professor Jimmy Steele of Newcastle University has been examining the provision of dental care since 2009 and he explained a little bit more about this and why the profession needed changes anyway…
Jimmy Steele: There was a new contract introduced in 2006 for dentistry and I think it’s fair to say it wasn’t awfully popular. There was then a Parliamentary health select committee report in 2008 that was actually fairly scathing about the system that had been introduced. So following on from that the Secretary of State asked for an independent review and I was asked to lead that. What in essence we were trying to do was to look at and for a system of providing dental services, which is appropriate for the health of the population that we have now. Dentists complained that they weren’t being rewarded for preventing disease, so the system perpetuated a kind of drill and fill mentality.
BH: But what does all this mean for the local dentist? I spoke to Nigel Hill, a General Dental Practitioner in Greater Manchester and asked him how much he knows about the changes.
Nigel Hill: We’re not really certain, what we do know is that it’s going to be a centralised national body which will commission us probably under the basis of a capitation contract. You get paid so much for every patient on your list. Currently we’re paid on the basis of a fixed contract value for which you have a unit of dental activity target. And in a lot of ways this is a return to the previous system where a local health body did organise your contracts but it was monitored and paid via what used to be the Dental Practice Board.
BH: One major consideration with such reforms is whether or not patients will notice these changes?
BC: Patients should be aware because they should get better outcomes, we’re going to move away from paying for activity they will probably in the long run get less intervention and more prevention and if you look at the oral health of the country that’s completely right.
CB: The dentists who are the providers of these contracts will just be offering these services as they always do; it’s their business, it’s their practice. I would see that they would carry on offering and delivering on their contract and delivering on their business. And patients are very unlikely to know that there’s anything happening on the reforms.
BH: But what about the day-to-day life of the dentist? Will a national body change the way they work?
NH: It’ll become more difficult to do administrative things. Currently we get payments and we deal with them by talking to our local PCT, what’ll happen is we’ll have to talk to a much more distant body,. For instance, we have to have CRB checks. We can just drive down to the PCT, what it’ll be in the future we don’t know.
BH: And what Mr Hill hits on here is the fact these are very early days for the reforms. With 2 years of pilot studies being implemented, and the same amount of time before the PCTs are abolished there’s still a lot left to be decided upon, particularly the role of dental professionals within the commissioning board, as Mr Cockcroft described…
BC: The only thing we know is that David Nicholson is going to be the Chief Executive of the commissioning board and I think announcements are going to be made over the next couple of months that will set out what the high level structure of various organisations is going to be. But certainly, if the commissioning board’s going to have responsibility for commissioning dentistry it will need some people within its structure who know and understand how dental services can work.
BH: Finally, I asked my contributors what was still left to be addressed, and what challenges face the profession. While they admit it may not be easy, there is resounding support for reforms.
CB: It’s making sure that this opportunity is used to really think through how could things be different for dentistry and get that message through and one thing I strongly believe in is using the clinicians, people who’ve provided NHS dentistry for a number of years and to support them, be able to articulate what they would like to see from the local contract and to fully engage them, and involve them.
JS: I think we’ve got a positive stance about the move to bigger scale commissioning for dentistry, but it will be tough and it’ll be very very difficult to implement and get it through. I don’t think anyone should be under any illusions about that. It’s a really really hard thing to do.
BC: It’ll always get ever so slightly sticky because that’s when reality starts to hit, but I’m really optimistic at the moment.
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