1 Introduction
1. The way in which NHS dental services are provided
and commissioned has recently undergone significant change. Although
there have been great improvements in oral health over the last
fifty years, the provision of dental services has attracted negative
public and media attention for over a decade. The 1990s were marked
by increasingly difficult relations between the Department of
Health and dentists. Later, reports of long queues of patients
hoping to register with a newly established NHS dentist added
a vivid, if in many places misleading, image of a system that
was under intolerable strain. In 1999, faced with increasing disquiet
at the state of NHS dental services, the then Prime Minister,
Rt Hon Tony Blair MP, committed the Government to ensuring that,
within two years, access to an NHS dentist would be available
to any one who wanted it.
2. In July 2000 the Department restated the Government's
commitment to improving access to dentistry in the NHS Plan:
A Plan for Investment, A Plan for Reform.[1]
The same year the Department published its strategy to meet this
commitment in Modernising NHS Dentistry: Implementing the NHS
Plan.[2] In 2002 it
published NHS Dentistry: Options for Change which contained
recommendations for radical changes to the NHS dental service.[3]
In 2004 some of the proposed changes were piloted by dentists
working in Personal Dental Service (PDS) pilots across the country.
In April 2006 a new General Dental Service (GDS) contract was
introduced. At the same time a new contract for orthodontic services
was implemented.
3. The new contracts changed the way in which
dental and orthodontic services were commissioned by the NHS and
the way they were provided by dental practitioners. The Department
faced the challenge of adapting the dentistry system to ensure
that patients who required dental treatment from the NHS could
obtain it more easily while at the same time retaining a dental
profession committed to providing treatment within the NHS. The
new arrangements were also intended to take into account a fundamental
shift in public dental health needs over recent years from a focus
on ensuring that teeth were healthy and pain-free to an increased
emphasis on their cosmetic appearance.[4]
In addition, the Department expected that changes to the remuneration
system would encourage dentists to switch their treatment patterns
from active treatment to a greater emphasis on prevention.[5]
4. The contract introduced in April 2006 made
significant changes, notably:
- Primary Care Trusts (PCTs)
were given powers to commission services to meet local needs (previously
commissioning had been done centrally by the NHS).
- The charging system for patients was simplified.
- The system by which dentists were remunerated
changed from a fee-per-item of treatment provided to payment in
return for an agreed annual level of service provision.
5. The new arrangements, which had been postponed
from their original implementation date of October 2005, were
received without enthusiasm by the dental profession. Many dentists
felt particularly concerned by the terms of the new remuneration
arrangements. Concern was also expressed by dentists and patient
groups about the ability of PCTs to commission dental services
effectively and whether the new arrangements would improve preventive
care or access to NHS dental services in areas where they were
in short supply.
6. In 2006 we looked briefly at the issue of
dental charges as part of our Report, NHS Charges. We decided
that it was too early, at that stage, to assess the impact the
changes to dental charges had had on dental services and we resolved
to explore the matter further once the new contract had bedded
down.[6] We recommended
that after one year the Department should institute a review to
report on the effects of the new contract and we listed parameters
to be covered.[7]
7. In August 2007 the Department published an
initial evaluation of the new arrangements for dentistry, NHS
Dental Reforms: One year on.[8]
The report concluded that "This first year of the dental
reforms has helped lay much more secure foundations for the future".
8. In October 2007 we announced an inquiry into
dental services. Its terms of reference were:
- The role of PCTs in commissioning
dental services;
- Numbers of NHS dentists and the numbers of patients
registered with them;
- Numbers of private sector dentists and the numbers
of patients registered with them;
- The work of allied professions;
- Patients' access to NHS dental care;
- The quality of care provided to patients;
- The extent to which dentists are encouraged to
provide preventive care and advice;
- Dentists' workloads and incomes; and
- The recruitment and retention of NHS dental practitioners.[9]
9. Our inquiry follows this Committee's previous
inquiries into NHS dentistry in 1993 and 2001. In 1993 the Committee
produced a report, Dental Services, which looked at the
funding of NHS dentistry.[10]
In 2001 our predecessors' report, Access to NHS Dentistry,
[11] examined the
issues affecting patient access and expressed concern that the
Department's plans for improving access, as outlined in Modernising
NHS Dentistry: Implementing the NHS Plan, might not be effective.[12]
10. We received 50 written submissions from consumer
groups, patient organisations, practising dentists and orthodontists
working in both the NHS and the private sector, dentists' representative
organisations, and associated trade bodies. We held four oral
evidence sessions during February and March 2008 with, amongst
others, a dentists' campaigning group, PCT commissioners of dental
services, public dental health experts, the Chair of the British
Dental Association (BDA) Executive Board, the Chief Executive
Officers of the Dental Practitioners' Association (DPA) and the
British Orthodontic Society (BOS), Citizens Advice, the Patients
Association and practising dentists. We also held evidence sessions
with Mrs Ann Keen MP, Parliamentary Under Secretary of State for
Health Services, and the Chief Dental Officer for England, Dr
Barry Cockcroft.
11. Our report first examines the system which
was in place for delivering dental services from the establishment
of the NHS in 1948 to the introduction of the new contract in
2006. In the following chapter we look at how well the new system
has operated over the last two years. We examine the four main
"success criteria" by which the Department clamed its
policies should be judged. We then consider the issues dental
services might face in the near future before concluding with
recommendations for improvement.
12. We would like to thank all those who submitted
written evidence to this inquiry. We are grateful to our specialist
advisers, Professor Kenneth Eaton and Dr Paul Batchelor, who provided
us with expert advice throughout the inquiry.
1 Department of Health, The NHS Plan: A Plan for
Investment, A Plan for Reform, Cm 4818, July 2000 Back
2
Department of Health, Modernising NHS Dentistry: Implementing
the NHS Plan, September 2000 Back
3
Department of Health, NHS Dentistry: Options for Change,
August 2002 Back
4
Ev 1 Back
5
Ev 2 Back
6
Health Committee, Third Report of Session 2005-06, NHS Charges,
HC 815-I Back
7
Ibid. Back
8
Department of Health, NHS Dental Reforms: One year on,
August 2007 Back
9
www.parliament.uk/parliamentary_committees/health_committee/hcpn151007.cfm Back
10
Health Committee, Fourth Report of Session 1992-93, Dental
Services, HC 264-I Back
11
Health Committee, First Report of Session 2000-01, Access to
NHS Dentistry, HC 247 Back
12
Department of Health, Modernising NHS Dentistry: Implementing
the NHS Plan,, September 2000 Back
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