Memorandum by Brian Bird (DS 16)
Report prepared by Brian Bird on behalf of the
PPI Dental Working Group led by Mrs Marjorie Brace
Prior to the formation of the Devon PCT in the
autumn of 2006, NHS Dental Services and funding were managed by
the various "Locality" PCTs. Involvement by the PPI
varied from a watching brief to inclusion of representation in
the SH & WD PCT Dental Contract Implementation Group. The
Government promised access to the service for all over five years
ago, but this has remained low and generally less than 30%.
The promise of an improved service and access
following the changed procedures operative from April 1st 2006
has not been seen to be a complete success by either the dentists
or the public, but for different reasons. Pilot schemes were run
in cooperation with dentists on the proposed changes, with plans
to change from GDS contracts to the new PDS ones.
These changes guaranteed the supporting dentists
significantly higher incomes for providing full time NHS services
(designated as 10 half day sessions/week). At April 2006 this
was expected to pay them £80,000 plus a further £80,000
for Admin/Surgery costs etc. The Trust has confirmed that the
figures quoted are averages based upon a quote by the Health Ministerdentists
who moved from GDS to PDS did not get a pay rise to the above
levels, their contract sum was based upon their historic NHS earnings.
The dentists, we believe, recognised that GPs
were being offered better deals and that not accepting a complete
NHS contract was going to be more lucrative. In fact many dentists
opted to treat only children or children plus benefit seekers,
excluding other adult patients with potential for greater income
generation as private patients. These dentists just informed those
patients that they were de-listed as NHS patients.
However the PCT has said that the only restricted
contracts which were agreed by PCTS reflected existing practice
arrangements ie changes which had been made before the contract
was introduced. It has been Devon PCTs policy to award new contracts
to provide services for all groups of patients. No contracts restricted
to particular patient groups have been awarded since the new contract
The PCTs, with approval of the DOH, took the
easy way out and allowed discriminating contracts, both GDS and
PDS, to operate. This has led to excluding the majority of people
who are paying or have already paid for over 40 years into the
National Insurance Scheme.
The effect on this group of citizens is a public
disgrace, with the lower paid and pensioners unable to access
and pay for dental care. The Commission for Patient and Public
Involvement Dentistry Watch report confirms these views.
The DOH needs to provide information on how
they arrived at the present charges to the public. The present
charges appear to be realistic and easily understandable. However,
the lowest charge, that for inspection and cleaning, meant just
that. It is not being implemented as dentists invariably charge
extra for cleaning, using their dental hygienists and Denplan
contracts to charge extra.
The basis on which Units of Dental Activity
(UDAs) was calculated and payments made was, in our view, flawed.
Our representative on the DCIG raised concerns at the time that
the payment of £25/UDA was not soundly based. This payment
has been questioned elsewhere as well as the case for additional
UDA payments to be reviewed and paid at significantly lower rates.
The foreign dentists, with few exceptions, have
been well received locally. Our concerns are that with open short
term contracts operative, they can quickly revert to private practice,
which some are reported to have done already. This needs to be
confirmed as millions of pounds have been spent on recruitment.
The PPI Forum and members of the public believe
that the Government has no real evidence, in spite of increased
numbers of dentists, that access has significantly improved across
the South West, which was below 30% prior to April 2006. Any claims
by the PCTs and Ministers that almost all the public has access
to NHS dentistry cannot be substantiated. No accurate statistics
can be arrived at from the information gathered and reported by
the "Information Centre for Health and Social Care"
and endorsed by the Devon PCT.
The basis of Government funding, we believe,
needs to be subject to closer independent scrutiny.
Firstly, that adequate and equitable funding
is made available for all residents wishing to use the service.
Until sufficient dentists provide a non-discriminatory service,
the Government needs to consider providing vouchers for treatment
by private dentists in the UK or within the rest of Europe.
We are frequently asked why is it that non-UK
nationals (illegal entrants and visitors) can obtain free treatment
as benefit seekers, while payers into the system are excluded.
Perhaps this level if discrimination needs to be tested in the
European Court of Human Rights.
Report to the DCC Health Overview and Scrutiny
Committee 22/10/2007 by the Devon PCT Primary Care Manager (appendix
We wish to table this report (appended) to illustrate
the latest position in Devon and comment as appropriate.
The reported shortfall, we believe, can safely
be attributed to the ready acceptance of discriminatory contracts,
as already explained. It is noted that other factors that may
contribute to the shortfall include under-performance against
contract and closure contracts.
The number of dentists employed does not reflect
the sessions they actually work for the NHS.
Patients Accessing NHS Dentistry
The method of generating the statistics gives
little clue to the total percentage of patients accessing treatment.
The 24 months' figures do not recognise the difference between
the number of patients treated and patient visits which can be
markedly different. This method of calculation glosses over the
shortcomings, which the PCT recognises in the last sentence of
Recruitment of Dentists
Based on the increased numbers from June 2006
(330) to March 2007 (360), you would have expected more patients
to be treated in the period under review. Again, perhaps a reflection
of part-time participation in providing NHS service.
These are sparsely placed and the waiting lists
still long. Locally orthodontic service is poor. Oral Health is
only being practiced for private payment.
The PPI Forum and public welcome the renewed
proposed Government initiatives to improve the service and access.
It may well be that our experiences of inadequate
NHS Dental Services in Devon are reflected in many other rural
counties, with promises that have failed to materialise to date.
The Devon PPI Forum Dental Group would be prepared
to appear before the Health Select Committee to present our case
and input a balanced view on behalf of the public, whose wider
views have been reported in Dentistry Watch.
Devon PPI Forum member