APPENDIX 4
Memorandum by Mr Stephen Day (D 16)
I am a dental practitioner in general NHS practice
with a special interest in endodontic treatment and I receive
referrals in this field to my practice. Consequently I see and
treat failures of endodontic treatment, mainly from the NHS sector,
many of which could have been avoided with suitable initial treatment.
My feeling shared by many others is that the
present Statement of Remuneration allows substandard endodontic
treatment in the NHS that has to be corrected later on with more
unnecessary expense involved. That Committee was circulated with
copies of a report published in two parts in 1997 and 1998 in
the Dental Practice Board magazine, Dental Profile[1]
which showed very low success rates for this treatment, in the
order of 10 per cent. 4.6 per cent of the claims had no discernible
root-filling present at all yet fees had been paid for this. The
present monitoring system by the Dental Reference Service is ineffective
in assessing claims for endodontic treatment since no post root-filling
x-ray film is asked for nor copies of the notes. An x-ray film
is the only way of assessing a root filling satisfactorily.
Access to Dental Services requires money and
dentists. Presently money is being wasted on ineffective root
filling treatments as the present Statement of Dental Remuneration
allows ineffective and outdated techniques and materials to be
used. This incurs more expenditure for the NHS when later corrective
treatment is needed to treat the failures. Dentists are reducing
their NHS commitment to be able to carry out this sort of treatment
effectively. It requires more time and the use of adequate equipment
that is expensive, neither of which are funded by the very low
NHS fees. In addition the medico-legal concerns at providing inadequate
treatment are becoming more apparent. To continue working in the
NHS doing this treatment will expose the dentist to possible erasure
if compromise treatment techniques are forced on them by virtue
of the economics of low NHS fees.
Questions should be asked of the Department
of Health why they have not changed the Narrative of the Statement
of Dental Remuneration to insist on the use of materials and methods
of treatment in line with current teaching practice. They were
asked on 7 December 1998 by the Narrative Sub-Committee of the
GDSC of The British Dental Association to remove silver points
from the Narrative but they refused to do this in spite of the
fact that this technique is ineffective, outdated and not taught
anywhere in the Western World. The Dental Practice Board should
be asked why the monitoring system allows claims for inadequate
treatment to be made. Over £40 million a year is spent on
root canal treatments in England and Wales yet no x-ray film is
routinely asked for to check on the treatment carried out. This
would not be difficult to organise with the use of double film
packets for the final film, for which incidentally there is incredibly
no requirement in the Narrative.
Dentists are leaving the NHS because it is increasingly
impossible to maintain treatment standards with the present fee
scale and so there is an increased risk of medico-legal compromise.
Many want to stay within the NHS as I do but we are being forced
out by the poor economics of the present system if we are to maintain
our professional integrity.
January 2001
1 Not printed. Back
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