Examination of Witnesses (Questions 80-99)
DEPARTMENT OF
HEALTH, CHIEF
DENTAL OFFICER
FOR ENGLAND,
DEPUTY CHIEF
MEDICAL OFFICER
FOR ENGLAND
14 DECEMBER 2004
Q80 Jim Sheridan: I know this report
is restricted to England and Wales. Have you any idea how that
situation operates in Scotland?
Sir Nigel Crisp: They do not have
Primary Care Trusts. I am afraid I do not know the exact arrangements.
Professor Bedi: In preparation
for this, as I always do, I spoke to my counterpart, the CDO in
Scotland, and they are going through a major consultation, as
we did in 2002. They are looking at a new way of systems and that
consultation has just finished and they are just going through
the responses of how the different sectors, the patient groups,
voluntary organisations and the dental professionals, want to
change NHS dentistry in Scotland.
Q81 Jim Sheridan: Again I will focus
on anecdotal evidence that I have of speaking to people who have
been to the dentist. Where this report is related to England and
Wales people who want NHS treatment depend on dentists providing
that treatment. I have been told that some dentists use substandard
treatment and equipment when treating NHS patients on benefit.
Is that off the mark or is that accurate?
Sir Nigel Crisp: I cannot comment
on your individual anecdote but as a matter of principle that
must be wrong. They should work to the standards which we have.
Q82 Jim Sheridan: So in terms of caps
or crowns or fillings, whether you are on benefits or whether
you are paying for the treatment, everyone in your opinion gets
the same treatment?
Sir Nigel Crisp: Sorry; if you
are talking about people receiving NHS treatment, yes. If they
are receiving private treatment they may get different materials.
Q83 Jim Sheridan: If they are in for
a filling or a cap—
Sir Nigel Crisp: If they are having
NHS treatment there should not be any discrimination between people
whether they are on benefits or not. In private practice they
may do different things.
Q84 Jim Sheridan: So if somebody goes
to a private dentist for a filling they will get different treatment
from somebody on NHS dental treatment?
Sir Nigel Crisp: They may do.
Q85 Jim Sheridan: So there is substandard
treatment?
Sir Nigel Crisp: No, that does
not mean to say it is substandard.
Professor Bedi: There is one type
of care. A professional acts professionally and provides one standard
of care. There are certain groups—children, pregnant women
and nursing mothers and those on low income—whose contribution
to the cost of treatment is met by the state. They are exempt
from patient charges but the standard that they receive should
be universally of the same quality as any other NHS patient.
Professor Halligan: I think your
point is very fair and I never ignore anecdote. I suggest to you
that in general terms most dentists are caring and ethical. However,
there is always a concern that people will behave less than acceptably.
The new contract is measured in two ways: in the complexity of
treatment given and the actual course of treatment. Beyond that
there are 11 days a year for dentists to understand their duties
of accountable care as professionals. One of them would not be
to differentiate between private and public patients. That is
anathema to everything that we stand for in the NHS and that is
something that we need to emphasise more and more. If we invested
more and more in developing quality professionals understanding
what best practice is, which is what this is all about; this new
contract is evidence based, we would not have the sort of anecdote
that you have just described.
Q86 Jim Sheridan: I am extremely glad
to hear that. Going back to the question about salaries, the previous
witness suggested that the figures quoted of £140,000 or
£150,000 did in fact take into account staff costs, accommodation,
that kind of thing. Is there a maximum in the way that Members
of Parliament have a maximum amount of allowances that they can
claim for staff and accommodation?
Sir Nigel Crisp: Are you talking
about if they are working in the private sector?
Q87 Jim Sheridan: Yes.
Professor Bedi: Dentists earn
a gross fee and there is an agreement with the Inland Revenue
that there is a percentage of that gross fee that they should
address for expenses. It is part of an annual discussion we have
when we look at the pay of dentists and it usually works, if I
am right, at 55% of the gross fees, so when I say that in 2005-06
it is £69,000 for someone working reasonably within the NHS,
the gross fees may be in the region of £140,000 but the difference
between those figures is to meet practice costs, nurses and other
expenses.
Q88 Mr Field: Sir Nigel, can I ask the
basis of this Report? I know after this afternoon's proceedings
in the House, when none of us knows what we are voting on, that
the pot should not be calling the kettle black, but you are saying
that they were not negotiations; they were discussions and that
discussions have now been called off, like negotiations used to
be in the old days. This document, however, talks about a new
contract, does it not?
Sir Nigel Crisp: Yes indeed. That
will be between the PCTs and individual practices. It is exactly
the same as with GPs where the NHS Confederation negotiated a
contract with the BMA around primary care and then the BMA organised
a vote of their members as to whether or not they would accept
it, but the actual negotiation had to be done by the PCT.
Q89 Mr Field: So when will this come
into operation?
Sir Nigel Crisp: October.
Q90 Mr Field: But if you look at paragraph
2.30 of the Report, it says, "Primary Care Trusts will therefore
need to establish effective arrangements for monitoring access,
oral health and patient satisfaction", but it is all going
to come in in October?
Sir Nigel Crisp: We are bringing
in the new contract in October.[5]
Q91 Mr Field: Of next year?
Sir Nigel Crisp: Of next year.[6]
Q92 Mr Field: So they have almost a year
to run?
Sir Nigel Crisp: Yes. Part of
the reason for having a delay was listening to the profession
about how much work they believed needed to be done in order to
do that because the original date was April, so we have put it
back to October.
Q93 Mr Field: But you talk in the document,
Sir Nigel, about guaranteeing the fee income and that somehow
dentists should not be on this treadmill. We are on a treadmill,
you are on a treadmill, my constituents are on a treadmill. Why
should dentists not be on a treadmill? We want them to deliver
some outputs, do we not, tangible ones which we can measure?
Sir Nigel Crisp: We do indeed,
and that is why we are going for a framework contract which basically
says that by moving to this new arrangement which is more preventative
and more appropriate so that you do not have to have a check-up
every six months; you can stop having unnecessary check-ups and
that is the treadmill bit, that will release the benefit of a
certain amount of time. We are saying that part of that time we
want dentists to use for their professional development in quality
and part of that time we want to secure more access for patients.
Q94 Mr Field: If we go back to one of
the Chairman's first questions, it was about whether we do not
now provide an NHS dentist service throughout the country and
you rather skilfully said that the aim is still to do that although
we will not deliver that. Do you not think it is more difficult
to deliver that if, for example, my constituents cannot get onto
the books of a local NHS dentist if you are bringing in a contract
which is telling dentists that they should spend quite a lot of
their time doing things other than what my constituents most need,
and that is not just in cases of emergency when we are beside
ourselves with pain but that we have a general service like we
do with the doctor?
Sir Nigel Crisp: If I may literally
take your constituency as an example, as it happens your constituency
went live on 1 January with a pilot for this, a field site. Forty-four
practices joined. They went onto this new system and as a result
at the end of October 4,600 new NHS patients have been able to
get onto the lists.
Q95 Mr Field: You say "my constituency".
It is four constituencies, is it not?
Sir Nigel Crisp: This is The Wirral
field sites.
Q96 Mr Field: The Wirral has some very
different areas in it. I pushed the PCT to give me the breakdown
for the four constituencies because I guessed there might be differences
where these new patients were picked up but they could not provide
that. Might you push them for the figures?
Sir Nigel Crisp: I will absolutely
push them because part of what we are trying to do is to deal
with inequalities.[7]
Q97 Mr Field: Although we cannot break
down the figure we have still only got 60% of residents in Wirral
who feel they have got the service that the Chairman was asking
about and that is that they know who their dentist is. Because
of this special effort we have managed to get over half. It is
an achievement. I am really pleased that they have done it, but
it shows the mountain to climb, does it not?
Sir Nigel Crisp: I think it does
but you also deal with another point here which is that because
we are changing the nature of the service some people will still
be saying, "Do we not need to have six-month check-ups and
is this not just the government saving money by not doing that?",
whereas my colleagues argue that you need check-ups when you need
check-ups.
Q98 Mr Field: I am happy with that. I
have two other points. Under this new robust system we are going
to get do you think bad debts will rise or fall? They will rise,
will they not?
Sir Nigel Crisp: I do not know.
It is not something I have considered but I will now consider
and I do not know whether colleagues know that, whether the PCTs
will be better debt collectors than individual dentists.
Professor Bedi: With this new
system we have looked at some of our field sites and pilots where
there is bad debt and how charges are being collected and we are
getting mixed results with regard to that, but it is new both
for the patient and for the dentist. We are learning through the
field sites about bad debts and about patient charges. One thing
for certain is that we need to make patient charges simpler.
Q99 Mr Field: Is not collecting bad debts
part of the treadmill you are trying to get dentists off? It is
part of the job they do not want to do. Doctors do not want to
sign sick notes. Everybody wants somebody else to do the nasty
side of their job and they just want to pick up the nice side
of the job. Can I just leave that with you?
Sir Nigel Crisp: Please, and I
can come back to you, because I do not know the answer.[8]
5 Ev 23 Back
6
Ev 23 Back
7
Ev 24 Back
8
Ev 25 Back
| 
