Memorandum by General Dental Practitioners
from the Coventry Local Dental Committee (DS 17)
The role of PCTs in commissioning dental services
Primary Care Trusts (PCTs) often do not try
to understand the working pattern of Dental Practices but try
to impose their own management agenda. This is often because they
do not have any Dental knowledge themselves.
PCTs should have a Consultant in Dental Public
Health to give them advice, but in Coventry there is no such person
PCT Officers often have the attitude that as
long as Units of Dental Activity (UDAs) are delivered, they are
not bothered how this activity is delivered.
The new contract is failing the requirements
of high needs patients.
Commissioning mechanism is not transparent,
as practices with General Dental Service and Orthodontic contracts
were unfairly treated in not allowing for similar number of patients
to be treated prior to the change.
PCTs are often sitting on the money rather then
spending it on patient care, in instances where a practice may
not utilise its total UDA allocation.
PCTs tend to assume that the work output will
be uniform day in day out without recognising that patient through
put can vary for any number of reasons.
PCTs need to recognise that the quality of dental
service provided has to be taken into consideration as well as
some quantitative measurement, rather then penalising practices
financially if they are not delivering the total UDAs.
PCTs need to recognise that they are relying
on the goodwill of dentists who have invested very heavily in
their practices to deliver high quality of dental service.
Orthodontic Service is suffering, as this service
needs to be commissioned properly.
There is no Consultant in Orthodontics support
Numbers of NHS dentists and the number of patients
registered with them
Under the new contract, dental patients are
not registered with any practitioner.
Previously dentists were paid a nominal fee
for registering patients and the dentist was responsible for providing
that patient continuing care as well as providing emergency care.
Although the number of NHS dentists may have
increased, the amount of work done has decreased.
Number of dentists has been recruited from abroad.
They are not familiar with the NHS system and therefore require
further training in order to obtain Vocational Training number.
Therefore the quality of service provided will be affected.
Orthodontic dental services are also in chaos
as practices, which previously could provide orthodontic service
and still can provide NHS Orthodontic care are being forced to
abandon patients because of their small orthodontic contract values.
These practices are being asked to have waiting lists, where none
existed before and if the circumstances are suitable there is
still no need for waiting lists.
In Coventry, we do not have a Consultant in
Orthodontics and therefore no Consultant Orthodontic support available
to General Dental Practitioners.
Therefore patient needs cannot be adequately
Number of private sector dentists and the number
of patients registered with them
In Coventry about 15% of practices have gone
private after the contract came into being. Therefore patients
are being forced to receive private dental care, whereas before
1st April 2006, patients were able to obtain NHS treatment at
Therefore there is a question mark as to whether
access has improved or deteriorated.
The work of allied professions
Under the NHS, very few Hygienists employed.
The contract is not very conducive to employing Hygienists or
Patients' access to NHS dental care
In some areas of Coventry, access seems to have
improved as dentists are advertising for dental patients.
However there are other parts of Coventry where
practices have gone private and therefore patients in those areas
will have difficulty getting NHS dental care unless they are willing
The way Dental Charges are levied tends to put
patients off dental services as sometimes a patient may need only
a small filling and they are having to pay a same charge as someone
having ten fillings.
PCTs also look at the dental charges as a way
of increasing their revenues.
The quality of care provided to patients
Under the new system, complex treatment needs
are not being addressed. Some nervous patients would benefit from
use of sedation techniques. However as these techniques are time
consuming and require further training and investments, there
is no incentive under the new contract to provide these services.
Therefore quality of care provided has deteriorated.
As mentioned earlier, orthodontic treatment
is not easily available to patients and therefore quality of care
has deteriorated. There is very little incentive to provide preventive
Health gains and quality indicators or number
of patients treatments satisfactorily completed should be measured
rather then Units of Dental Activity.
Dental activity should be to do with improvement
in oral health of patients rather then just measuring fillings
General Dental Practitioners are better placed
to look after patients rather then PCT administrators, as there
numbers seems to be increasing all the time just to monitor statistics
and create unnecessary paperwork. Therefore inspiring to improve
quality of care is not present in the new contract.
The requirement to come close to target is very
difficult, as the treatments should not have to be tailored just
to meet the right target.
The extent to which dentists are encouraged to
provide preventive care and advice
As mentioned earlier, there is very little incentive
in the new contract to provide preventive care and advice. There
should be incentives to reduce the decay experience of the public
by use of oral health promotion techniques, fluoridation applications,
and fissure sealant applications.
If these encouragements take place then better
use could be made of Hygienists and Therapists.
Dentists' workloads and incomes
Dentists are highly trained professionals and
they are best placed to deliver a high quality appropriate and
effective dental care to the public. It seems fewer dentists are
doing more work.
If a dentist sets out to provide a high quality
dental care to all his or her patients, the dentist may not achieve
the targets set. Therefore the dentist is financially penalised
which seems so unfair for a person who is trained to put the interests
of his patient first.
Dentists would like to be paid for providing
higher quality of dental care.
It is high time that PCTs should stop looking
at treatments, which generate patient charge revenue only.
Continuing education is very important for any
professional person and therefore protected learning time should
be there in reality rather then just on paper.
Every Dental Practice should be provided with
sufficient resources, so that all staff and dentists can be adequately
remunerated and the patients can receive the dental care in the
best safe environment.
Under the new system, it is very difficult to
set up a new practice. This would also reduce the choice for patients.
The recruitment and retention of NHS dental practitioners
There is no recruitment of practitioners. If
practitioners do not provide sufficient patient charge revenue,
there is no security of employment. Recruitment is likely to decrease,
as fewer newer practices will open.
Vocational Training is inadequate under new
contract and trainees get less experience compared to before April
2006. Trainees on completing their course cannot stay with same
practice and therefore there is no continuing care relationships
Retention of practitioners could be improved
by providing facilities for postgraduate course participations.
W Sidhu BDS (Sheff) MCDH
(Birm) DDPHRCS (Eng)
Honorary Secretary for Coventry LDC