UK - Government urged to engage with dental profession

Government urged to engage with dental profession
15th May 2009
The Westminster forum put pressure on the government to react pro-actively to the upcoming Steele report

Dental leaders have called for the government to work much more closely with the profession as the build-up to the release of a major review of NHS dentistry in England gathers momentum.

The rallying cry was made at a Westminster Health Forum keynote seminar entitled The Future of Dentistry, and comes as the profession eagerly awaits the publication of the independent review, led by Professor Jimmy Steele, of the University of Newcastle.

The review was commissioned last year following widespread criticism of the new contract from the House of Commons Health Select Committee, and is due for publication in mid-June.

It was the main talking point of the forum, held in central London on 12 May, and comes hot on the heels of Professor Steele's interview with Dentistry magazine last month in which he revealed his report would seek to address the frustrations felt by dentists and patients following the implementation of the new contract in 2006.

The over-riding message to come from the Westminster forum was that many speakers wanted the review to acknowledge the importance of direct and significant communication between the government and the profession.
Derek Waton
Derek Watson, chief executive of the Dental Practitioners' Association (DPA), said that the new contract was generally underperforming by 6-10%, and that more change was required. He said the DPA had tried to contact the government on several occasions to discuss the fallout of the 2006 reforms, but those requests had been turned down.

‘The government needs to engage in the democratic process,' he said. ‘The Minister responsible for Health, Ann Keen, will not speak to anybody, not just the DPA. I'd like to talk to the politicians... the government needs to kick-start the democratic process and, when they do, the DPA will be ready to engage.'

The tone had been set early on when the chair for the morning session, Doug Naysmith MP – a member of the Health Select Committee – explained: ‘The most important point to come out of the Health Select Committee was that the best way to provide quality dentistry is through the PCT working closely with the profession to commission NHS dental services properly.'

Susie Sanderson

Chair of the British Dental Association's executive board, Susie Sanderson, acknowledged that commissioning Professor Steele's review was a positive move on the government's part, and praised the way the report is being conducted in an open way. She said: ‘In my “glass half-full” moments, I think that the government is displaying a refreshing degree of honesty – albeit nudged somewhat by the Health Select Committee – and I really, really hope that I'm not going to be disappointed by it. The NHS brand has been damaged but let's not hope irretrievably.'

‘The UDA must be scrapped,' she added. ‘It does not encourage the kind of modern dentistry dentists want to practice. The continuing care relationship between dentists and patients needs to be appropriately appreciated.'

She said: ‘If I have to beg for one thing, it's that the DoH follows the review group's example and works with the profession to ensure that its recommendations work as well in practice as they are intended to do on paper.'

Looking forward to the results, Dr Sanderson was quick to stress the difficulty of Professor Steele's task, saying: ‘It's important to appreciate just how broad his remit is. The scope of the task cannot be underestimated; it's ambitious in both remit and schedule. The extent to which the government implements his recommendations will show how committed it really is to improving dental services.'

The Patients' Association's Anthony Halperin echoed the support for Steele, saying: ‘If the enthusiasm shown by Professor Steele and his team is taken forward, then we just may have a way for this system to be altered.'

While the existing system came under fire from several speakers, it was also widely accepted that there was still potential for positive change.

Darrin Robinson, director of clinical services and commissioning for Integrated Dental Holdings, summed it up by saying: ‘We've gone from an overcomplicated system to an oversimplified one. There is no perfect solution, but there is an improvement on what we have now. The Steele report is a massive opportunity to improve the delivery of healthcare and make things better next time around.

‘It's crucial that we pilot schemes properly and introduce them in a managed way, and that there is engagement with both big and small practices nationwide. Proposals might look good on paper, but if problems crop up with them in practice you lose the engagement of the profession.'

He also recommended linking the contract with a patient assessment scoring system, that would highlight which patients require a higher health need or a lower one.

The British Dental Health Foundation's president Chris Potts was more damning, saying: ‘I don't believe that tinkering with the current system will have any effect; fundamental change is required. We welcome the findings of the long-overdue Steele report; no change at all is not an option.'

Peter Robinson, Professor of Dental Public Health and deputy dean at the School of Clinical Dentistry at the University of Sheffield, said it was important to recognise that there never was a ‘golden age' of dentistry, and that access has been a long-standing problem. He said the three-band fee system was ‘a disincentive' for dentists to accept new patients, particularly those who need more treatment.

‘The new contract doesn't encourage a skills mix in practice,' he said. ‘There was no mention of therapists. I would want therapists to be remembered in all of this.' He also said the profession was ‘desperately short' of teachers, while student intake has increased by 28%. ‘Within education there appears to be a hidden curriculum that NHS dentistry is second rate,' he added.

‘The education sector needs to engage with NHS practices so students can learn first-hand that it's perfectly possible to produce and promote first-rate quality dentistry in the NHS.'

John Milne, chair of the BDA General Dental Practice Committee, said that under the current system of UDA quotas it was ‘easy to see how effective preventive advice could be squeezed out by dentists working to meet their UDA targets.'

He called for ‘targeted fluoridation of the water supply' to be recommended in the Steele report, as it would benefit people of all ages, particularly children and the elderly.

He said: ‘I would say to those people in the room from the political sphere – take courage, it can't be done without you.'

His comments were backed up by Professor Michael Lennon, chair of the British Fluoridation Society, who expressed his delight at the recent decision of the South Central Strategic Health Authority who, after an extensive public consultation, decided unanimously to add fluoride to the water of Southampton, and called for other SHAs to follow suit.

'I feel slightly frustrated at the slow pace of other authorities, especially in the north-west and Yorkshire,' he said.

The forum was rounded up by Lord Colwyn, member of the Science and Technology Select Committee, who said: ‘It is obvious to me that the new contract has failed to meet the government's own criteria for success.

‘The UDA is an unsatisfactory method of measuring dental activity. It relates to consumption of time and resources and based on an out-dated model. It was never properly tested and does not take into account preventive or quality care.

‘It is a crude measure of dental activity, and I believe it should go.'

Author
Paul Gadsby and Guy Hiscott

Extensive and expensive consultation (total costing over £400,000) with 72% saying NO to fluoridation the SHA still went ahead