Select Committee on Health Written Evidence

Supplementary memorandum submitted by the British Dental Association (CP 11A)

  Further to the oral evidence Dr Lester Ellman of the British Dental Association presented to the Health Select Committee on Thursday 9 February 2005, there were a number of points that came out of the session, which may be helpful for the committee to be clarified.

QUESTIONS 333, 346 AND 355

Children being seen on the NHS on condition of parents taking up a private dental plan

  Ms Charlotte Atkins and Mr Mike Penning raised the issue of constituents, and for Mr Penning personally, who have been told by their dentists that their children will continue to be seen on the NHS on condition that they [the parents] take up a private dental plan.

  Under the current General Dental Service (GDS) system there is nothing that prevents dentists from making it a condition of treating children on the NHS for their parents to be signed up privately. It is also important to put this issue in context. The BDA believes this practice of "condition" is a very recent phenomenon—happening only in the last two to three years, and exists at very few dental practices across the country. Nonetheless, the BDA does not encourage members to take this course of action.

  Under the new GDS Regulations, coming into effect on 1 April 2006, dentists can continue to hold their current contract value and attached Units of Dental Activity (UDAs) for the number of NHS children they have, but the policy of condition will not be allowed. However, there may be circumstances, where PCTs have agreed that dentists have a children-only NHS list and so the dentists will see all adults on a private basis.

  The BDA fully supports this specific aspect of the Department of Health's (DH's) wide ranging reforms of NHS dentistry, as it allows dentists to prioritise child oral health, to foster a good oral health regime in children and provide a key NHS dental service to children in areas that need it.


The BDA's collective view about the new GDS contract

  Dr Richard Taylor voiced the issue of the BDA's collective view about the new GDS contract. As Dr Ellman highlighted in his evidence to the committee (answer to Question 353), the BDA did not negotiate the contract with the DH: Due to the way the primary legislation—the Health and Social Care (Community Health and Standards) Act 2003—was drafted, it was entirely a Government contract, which the profession could input into at a later date, via discussions with the minister and officials.

  The BDA has made it clear to members throughout the reforms process that each individual General Dental Practitioner (GDP) needs to decide whether the new GDS contract is right for their patients, for them and for their businesses. The BDA offers advice and guidance to members on how best to plan for their futures. Some will be happy with the proposals being offered by their local PCTs, others will not be and will take appropriate decisions.

  However, throughout the process, the BDA has made its "collective" feelings clear on the contract—in December 2004, the BDA suspended discussions with the DH on the arrangements for a new base contract, arguing that key elements of the draft contract would not allow dentists to spend more time with their patients, to adopt a more quality-driven and preventive approach to oral healthcare, and improve the working lives of the dental team and the patient experience. Dr Ellman was quoted as saying, "we have been proactive in our discussions with the Department of Health but the traffic has been almost entirely one way".

  We supported the DH's decision in January 2005 to postpone the implementation of the contract from October 2005 to April 2006, citing the National Audit Office's (NAO) report, Reforming NHS Dentistry: Ensuring effective management of risks. November 2004, which raised significant concerns about the state of readiness among the PCT charged with delivering NHS dentistry.

  The BDA continued infrequent discussions with the DH, and agreed on a few issues, such as the children-only NHS list, but the overall well publicised BDA belief is that the new contract is untested and that the new way of monitoring targets for dentists is causing confusion across the NHS which is unable to cope with the new arrangements. In a BDA press release of 2 February 2006, "New dentistry contract will fail patients, British Dental Association warns Minister", we called on the Government to suspend the contractual requirement that means dentists must achieve an allocated number of "units of dental activity" (UDA) as part of the new monitoring system, as well as asking for greater clarity about funding for those practices which want to expand or have expanded during or after the test year (October 2004 to September 2005). Dr Ellman is as quoted as saying: "The situation is a shambles for both patients and the profession. Our fear is that the new contract will do nothing to improve access to care for patients or improve the quality of care. The Government claims to be committed to preventive care yet that does not seem to apply to dentistry. We're now faced with a contract that puts dentists on a new treadmill and means they can't give the care and time that they want to give to patients. This is bad for patients, bad for dentists and disastrous for NHS dentistry." These comments were supported by the BDA's General Dental Practice Committee, following the motion: "The British Dental Association believes that the Government's aims of securing patient access, improving oral health and raising the quality of patient care will not be achieved by the imposition of this target driven NHS contract."


Changes to the dental contract in Wales

  The new GDS contract in Wales is devolved to the Welsh Assembly. BDA Wales/Cymru's General Dental Practice Committee has been in discussions with the Welsh Assembly Government (WAG) regarding the precise details of the Welsh new GDS.

  The WAG has cautiously followed the "English model" towards the proposed GDS contract, but has made two significant improvements—changes to the output leeway and monitoring trigger. The DH claims that to "get dentists off the treadmill" they are going to set the individual practitioner contract values according to the level of item of service activity and earnings in the current year, minus 5% activity. In Wales, the proposed level of activity for equal funding is going to be lower—10% less. This is a very welcome move for dentists in Wales as, in theory, it gives them more time to spend with each patient, offering preventive care and advice and gives them a slight freedom from the treadmill.

  In reality we are concerned that as dentists are already working to address the needs of the people of Wales who have poorer oral health than in England, there will be little opportunity to free up time without affecting the standard of service and waiting times for treatment.

  The monitoring trigger, a device used by PCTs and LHBs to oversee activity outputs by individual practitioners, and is one of the contract measures—in England a 4% drop in agreed activity triggers an investigation by the PCT and has to be made up within 60 days.

  In Wales the LHBs will not contact practices until the contract figure falls by 5% from the agreed contract value and, if there is good reason there will be no need to make up the difference. This is particularly pertinent in the transitional period where dentists and LHBs will have to get used to the new ways of working very quickly. Again, this is advantageous to NHS dentists in Wales as it theoretically allows them flexibility and time to deal with the additional demands of administering a practice which include more clinical governance activity, the training requirements of staff, especially dental nurses and increasing health and safety requirements related to recent legislation.

  However, WAG has been slow to develop its strategy for the future of dental services, with their legislative programme a considerable number of months behind Westminster, but with the same 1 April deadline. To date, the GDS contract regulations are due to be debated in the Welsh Assembly on 1 March. This delay has inevitably caused considerable anxiety for BDA members.


Free oral health risk assessment programme

  In 2003, the BDA produced a report, Oral Healthcare for Older People: 2020 Vision, which emphasised that the reform of the NHS dental charging system needed to take account of the anticipated growth in the number of older people in England. It came up with 21 recommendations, including:

    —  A free oral health risk assessment should be available to patients from age 60, with referral to a dentist for a strategic long-term oral healthcare plan offered to those identified as likely to need complex restorative care.

    —  Planned reform of NHS dental charges should take account of the growth in the older persons population and the fact that older people are more likely to require more complex treatment and also tend to be among the least able to afford to pay.

    —  Information about full and partial exemption from NHS dental charges should be simplified and publicised to older people and carers.

    —  Free NHS examinations for patients aged 65 and over is likely to improve the oral health of the nation's older person's population greatly.

  Free dental examinations have already been introduced in Wales for people aged under 25 and those over 65 years. The Scottish Executive are currently implementing free dental checks for all, with over 60's being the first section of the population to receive it.

  The BDA supports preventative-led dentistry and supports the principle behind this policy. In fact, the BDA favours the development of a comprehensive oral health assessment as part of basic oral healthcare provision. However, it needs to be fully funded and the BDA has serious reservations, on two grounds, about the Scottish Executive's free dental checks policy—funding and workforce. There is neither a sufficient workforce nor money to provide and fund this initiative. We are concerned that patients' expectations would be raised and it will be left to dentists to deal with the consequences. Also, during the legislative scrutiny of primary legislation, which introduced this policy, the Smoking, Health and Social Care (Scotland) Act 2005, the Scottish Parliament's Finance Committee raised questions about the funding and financing of this policy.[8]

  However, given that the BDA would support "in principle" the ending of NHS dental charges, the action points above, were charges to be abolished, should be encouraged as "good practice" in the provision and delivery of oral healthcare for older people.

  The expert reference group for the report included representatives from the BDA, dental schools, the British Society for Gerodontology, Help the Aged and Age Concern.

  The BDA also played a key role in the Gerodontology Society's December 2005 report, Meeting the Challenges of Oral health for Older People: A Strategic Review. This report was commissioned and funded by the Department of Health. It recommended, among other issues:

    —  The Department of Health should consider ways of encouraging older people to use dental services on a more regular basis.

    —  All older people moving to care homes should receive an oral health and oral health risk assessment that considers both preventive and treatment needs.

    —  The Department of Health must continue to ensure the availability of free, comprehensive care for low income older people.

  Please find included with this supplementary memorandum copies of both reports—Oral Healthcare for Older People: 2020 Vision and Meeting the Challenges of Oral health for Older People: A Strategic Review.

  I hope this is helpful.

James Clark

Parliamentary Officer, British Dental Association

24 February 2006

8   "Your [the Scottish Executive Health Department] testimony this morning has convinced Parliament's Finance Committee that this financial memorandum does not fulfil the legislative purpose that is laid down for it constitutionally." "The Committee is inviting you to go back to consider whether the financial consider whether the financial memorandum fulfils its constitutional purpose of itemising fully the financial resources that will be required to implement the provisions in the bill." (Scottish Parliament Official Report. Finance Committee. 1 March 2005. Columns 2433-4). Back

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2006
Prepared 18 July 2006