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.
QUESTION 379
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."
QUESTION 38
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.
QUESTION 401
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
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