Memorandum by Castle College (DS 20)
1) The concerns raised in this submission
relate to the reduction in the prescribing of Dental Custom Made
Dental Appliances manufactured for patients of Dentists, through
UK dental laboratories by UK Dental Technicians. As regulated
members of the UK dental team, Dental Technicians are extremely
concerned that their livelihood and role is being lost from the
highly skilled Dental Care workforce. This appears purely due
to a change in prescribing by NHS dentists when "working
the new contract system" rather than related to patients
2) The effect has so far appears to be:
i. Loss of UK jobs in Dental Technology within
these private small medium enterprises.
ii. Individuals moving out of their highly
specialised Dental Care Profession role and a loss of fully competent
dental technicians from the UK workforce.
iii. A future need to any increase the provision
of NHS appliance prescribing is likely to be fulfilled by pan-world
supply of custom made dental devices, thus increasing imports.
3) Only local data is available regarding
the effect on dental technicians within the Oral Health care team,
as little or no information is collected centrally and they are
seen as non NHS employees. But are expected to respond to the
"Team Ethic" of dentistry.
4) We would welcome the opportunity to present
orally at the evidence sessions.
B.1 The work of allied professionals (Dental
a) Dental Technicians have seen their work
load adversely affected by a dramatic downturn in the NHS prescription
requests for Dental Appliances, since the April 2006 contract
introduction. Some Dental Laboratories have therefore gone out
b) This has both been; (1) reduction in
the number of appliance making requests, and (2) a reduced content
in NHS appliance prescriptions ie more single items requested.
c) There is local evidence that the types
of appliances requested under the NHS has also changed and this
is seen as requests for more low priced alternative appliances.
d) Dental Technicians are not part of the
NHS, but are an integral part of the dental team.
e) There has been a downturn in employer
recruitment of new trainees in many areas.
f) Loss of UK Dental Technology jobs followed
the introduction of the new contract, but no government body appears
to record such movement in specialist labour.
g) The apparent marketing of appliance to
Non EU based dental laboratories is likely to further decimate
the UK based Dental Laboratory industry.
B.2 Patients Access to NHS Dental Care
a) It would appear that NHS patient access
to Custom Made Dental devices has been reduced since the introduction
of the April 2006 contractrecords in SME's.
b) Generally a reduction in the type, volume
and actual numbers of NHS appliances seen.
c) The change in prescribing since April
2006 might be attributed to;
(1) Over prescribing in previous yearsN.B.
What evidence is available of such?
(2) Reducing the prescription value during
the initial phase of the new contract, or
(3) Dentists limiting prescribing of custom
made dental devices to control cash flow out of the dental practice
to maintain their own financial stability.
B.3 The quality of care provided to patients
a) Limiting the types of custom made dental
appliances offered under the NHS could for that proportion of
the general public who rely on the NHS for their dental care severely
limit options offered. Is approx 40% of UK population registered
with an NHS dentist?
b) The changes in prescribing of custom
made dental devices is concerning, if patients are only being
offered one restoration at a time, when three or four are required.
This might also be a consent issue.
B.4 The recruitment and retention of NHS dental
a) Dental Technicians are currently registering
to be part of the Oral Health Care team.
b) Dental Technicians training is highly
specialised and related to dedicated appliance constructing skill
competences (ref: Skills for HealthNational Occupational
c) Initial training takes 3+ years, on which
to build enhanced special skills. An ability to manufacture a
wide range of appliance requires years of dedicated personal training
and development. These skills have little relation to other vocational
d) Low recruitment for part time training
is now a factor, as employers working for the NHS are concerned
at a reducing NHS prescription value. Some are therefore looking
towards novel cost reduction or production of dental appliance
elsewhere eg China.
e) There has been a steady closure of training
establishments for Dental Technician throughout the UK. Some educational
providers have maintained their dental technology provision by
marketing to international students or solely to UK Hospitals.
f) Retention of dental technicians within
the Small Medium Enterprises who manufacture custom made NHS dental
appliances is mainly dependant on a continuation of prescription
requests for NHS work.
Director of Health Science and Manager of the School
of Dental Care Professionals