All change no change?

Recently I attended The Dentistry Show at the NEC and I was keen to attend the lecture on the new dental contract, being given by, among others, Professor Jimmy Steele.

Also speaking were Roger Matthews, Chief Dental Officer of Denplan, Elizabeth Lynam of the Department of Health and Liz Kay, Foundation Dean at Peninsula Dental School.

Considering the Steele report was first published almost 5 years ago and with the volume of discussion, pilot contracts and supplemental reports that have followed it, I was hoping to glean some insight into what is likely to replace the current flawed system.

Professor Steele shared his belief that through the NHS we could offer the best system of publicly funded dental care in the world. His ideas are laudable and one would be hard pushed to disagree with his basic message that we should aim to have a capitation-based system, focussing on prevention rather than cure.

However, from my perspective that was one of the few positives to come out of the debate. The government minister was keen to stress that the government would be thorough, taking time to review all the available data to ensure that the new contract is fit for purpose and capable of meeting the ideals espoused by Professor Steele.

One would think after a number of years of running pilot schemes that they would have a pretty good idea by now. However, it appears that this is not the case.

When faced with what appeared quite simple questions, such as “how are associates going to be paid?”, or how the contract will account for the huge problems that dentists working in inner cities will face in convincing their patients to follow their advice when it comes to prevention compared to those practicing in more affluent areas, the repeated response from the minister was: “We are aware that there are significant issues which need to be addressed and we don’t know how to address them yet”!

One may be forgiven therefore, for wondering exactly what the government has been doing for the past few years.

Indeed, my feeling of unease grew to concern when Roger Matthews, the Chief Dental Officer at one of the world’s leading expert organisations in operating capitation schemes stated that the government had not consulted Denplan at all during the pilot process. This is quite frankly beyond baffling!

Perhaps the government simply did not want to hear what the cost of running such a scheme, compared with what they have available to spend may be.

Liz Kay made the point that those of us from the baby boomer generation were not blessed to receive advice from an early age about how to protect our teeth and that there is therefore a significant portion of the population that is, over the next 20-30 years, going to require a considerable amount of complex and costly treatment.

So, how does that fit in with Professor Steele’s recommendations and the cost of implementation? Once again the minister was unable to provide a response.

There was talk of dentists having to get used to a “cultural shift” in the manner in which NHS dentistry is going to be provided. This was intended to indicate a shift away from cure and towards prevention, but my belief is that it could equally be taken to mean that the funding which has been available to support NHS dentistry in the past will not be available in the future and that low cost hygienists and therapists will replace a significant amount of the work currently being carried out by dentists.

This will in turn mean many fewer jobs for associates, that the downward trend in associate pay is going to continue for some time and that many associates are going to have to get used to not only a “cultural shift”, but wholesale changes in their lifestyle.

At the end of the debate one was left with the feeling, that this government really hasn’t

addressed the major issue facing NHS dentistry. How does the government, in times of extensive public spending cuts, drastically reduce the spend on NHS dentistry without severely cutting the income of NHS practice owners and thereby potentially leaving large swathes of the population unable to obtain dental care and dental treatment?

Given that there is an election next year, it may well be that this most contentious of issues is temporarily shelved and that it will be a number of years before the new contract is introduced. The worry, quite frankly, is that like the last administration, this government may introduce a contract, which is ill considered, creating more problems and bearing no resemblance to the pilot contracts on which so much time and effort have been spent.

It goes beyond disappointing that so long after the Steele report, the future still looks unclear with so many significant questions unanswered. It is perhaps the clearest evidence of the importance, or even the lack of importance, that our politicians attach to the provision of NHS dentistry.

There are I believe only two things which are relatively certain:

  1. At some point there will be a new contract, but at present no one knows at all what this is going to look like.
  2. When it does come in the government – no matter which party is in power – is going to want an awful lot more from dentists and in return is going to pay significantly less.

John Grant of Goodman Grant Lawyers for Dentists

 For more information call or John Grant on 0113 8343705

or email [email protected]



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