SUMMARY OF RECOMMENDATIONS
| (a) | We consider that the General Dental Service (GDS) remuneration system is the heart of the access problem. The fee structure encourages the move of dentists out of the NHS. It also discourages preventive dental care and the continuing maintenance of good oral health. The system has been reviewed comprehensively in the past, and both this Committee and the DoH developed options for alternative systems. Yet it remains unchanged. In the light of this history we do not advocate yet more reviews for their own sake, but rather action: we believe the time for reform is ripe. We recommend that talks should take place immediately between the Government and the profession's representatives to revise the GDS contract, taking account of:
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- previous reviews of the remuneration system;
- the current context in which GDS dentists are working,
including the new remit of the health authorities to improve oral
health;
- GDS incentives outlined in Modernising NHS Dentistry;
- GDS concerns about workload (including the Review Body
on Doctors' and Dentists' Remuneration study), standards of care
in the NHS and levels of clinical indemnity;
- future arrangements for registration, bearing in mind its
original purpose;
- exemplars provided by successful arrangements for the remuneration
of private dental care developed by organisations such as Denplan
(paragraph 22).
| (b) | We welcome the planned review of the dental workforce. We recommend that it should:
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- take account of discussions about remuneration between
the profession and the Government;
- cover the whole dental team and take account of the findings
of the Chief Dental Officer's review of women dentists' working
practices;
- look at the composition and distribution of the workforce
as well as its current size, and at anticipated trends, recommending
incentives to encourage dentists to work in areas which are presently
poorly served; and,
- advise on the frequency of subsequent workforce reviews
(paragraph 38).
| (c) | Modernising NHS Dentistry aims to bring dentistry into the mainstream of the NHS and reduce inequalities in oral health. We welcome this and the key role it gives to health authorities. However we are concerned that they do not possess the levers they require to meet the objectives of the strategy. We recommend that, with the help of health authorities, a study should be undertaken of the levers (formal and informal) which health authorities are currently able to apply to fulfil the objectives of Modernising NHS Dentistry. This should examine the limitations that impede the achievement of these objectives and, in conjunction with findings from the remuneration and workforce reviews, advise on how these limitations might be addressed. We recommend that in all these exercises the profession and the patients it serves should be fully consulted in a timely fashion. However we reiterate that such consultation should be a prelude to action rather than an excuse for inaction, and follow a strict timetable for implementation (paragraph 44).
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| (d) | We have received extensive written evidence and are quite clear that urgent action is required. We consider that dentistry has never been fully integrated into the NHS and as a result major health inequalities exist. We believe that the present arrangements for accessing NHS dentistry are inequitable, uncertain and getting worse; patients do not know where they stand. Unregistered patients find it hard to get any form of care. Registered patients can lose that status without redress and often without knowing they have done so. Patients do not always get the advanced conservative treatment they need (crowns, bridges, implants etc) through the NHS even when they are registered. Certain very vulnerable groups of patients, such as elderly people and those with dementia, face particular problems. We agree with the Eastman Hospital, that "there should be greater clarity and honesty regarding availability of NHS treatment." Modernising NHS Dentistry aims to address immediate problems of access. But these are, as the BDA told us, multi-faceted long-standing problems to which solutions will not be found overnight. There are widespread concerns that the proposals in the document merely provide a quick fix and do not go to the root of the problems. There are also concerns about current workforce levels and distribution, about which at present we have little detailed information. We believe these are serious concerns and that Modernising NHS Dentistry lacks the weight to alter fundamentally what is a deteriorating situation. We would suggest that a longer term strategy for dentistry within the NHS is still badly needed (paragraph 48).
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