|
Dentistry has been available through the NHS since the creation of the Service in 1948, and during that time oral health has improved dramatically. Most of the 23,000 dentists in England provide both NHS and private dentistry services. In 2003-04 total expenditure on dentistry in England was some £3.8 billion of which £2.3 billion was accounted for by the NHS and an estimated £1.5 billion by private dentistry. The NHS recovered £0.5 billion of this expenditure from patient charges.
Traditionally dentists are independent contractors who choose where to locate their premises, and how much if any NHS dentistry to provide. Over the last ten years there has been an increase in the number of patients experiencing difficulties in accessing NHS dentistry, as many dentists reduced their commitment to the NHS and developed their private work. Over the same time period there has been pressure for reform of the dental remuneration system, in which dentists are paid per item of treatment provided, mainly because it has tended to encourage intervention, rather than prevention as favoured by modern dentistry.
In 1998 the Department of Health established Personal Dental Services (PDS) contracts to pilot new systems for paying dentists and new ways of working. In 2003 major changes were announced in which Primary Care Trusts are to be given responsibility for commissioning NHS dental services in response to local needs, including having more influence over where dental practices are located. The Department set an April 2005 target date for implementation of new contracts for all NHS dentistry, subsequently deferred until October 2005.
On the basis of a Report by the Comptroller and Auditor General[1] the Committee examined the progress made by the Department in implementing its challenging programme for reforming NHS dentistry. In particular we examined whether the significant risks identified in the report were being managed, including the mismatch between supply and demand for NHS services, primary care trusts' ability to commission services, and variations in oral health.
We found that in areas with high levels of social deprivation there are relatively few dentists, while in more affluent areas many adult patients experience difficulties in registering for NHS treatment. The Department's 2003 workforce planning exercise indicated a need for 1,000 new dentists and it has introduced various initiatives, including recruitment from abroad and increasing the number of dental training places, to tackle these access problems. The new contracting arrangements together with new guidance on dental recall periods, which recommends that recall periods should be based on clinical need (of between 3 and 18 months) rather than the standard recall period of six months, are also expected to increase dentists' commitment and ability to provide additional NHS services.
Indicators of oral health show that twelve year old children in England have lower levels of decay than their European neighbours, and an increasing percentage of five year old children have no dental decay. There are wide variations in oral health levels across the country however, with children in some parts of northern England having, on average, twice the level of decay of children in other parts of the country. Likewise adults in northern England are twice as likely to have no natural teeth as those in the south.
Dentists remain concerned that the proposed commissioning arrangements will still not release dentists from the "treadmill" of being paid for treatment provided rather than focussing on prevention. The delay in publishing the details of the revised patient charges regime, and the lack of experience in primary care trusts of commissioning dental services, add to concern about the NHS's ability to implement the reforms effectively. Following the Committee of Public Accounts' hearing, the Secretary of State for Health announced that the timetable for implementation would be delayed until April 2006 to enable public consultation on key aspects of the new proposals, and to allow Primary Care Trusts to prepare for their new roles.
| 
