Select Committee on Health Written Evidence


Memorandum by Castle College (DS 20)

DENTAL SERVICES

A)  EXECUTIVE SUMMARY

  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 needs.

  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.

ISSUES RAISED

B.1  The work of allied professionals (Dental Care Professionals—DCP's)

  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 of business.

  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 contract—records 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 years—N.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 practitioners

  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 Health—National Occupational Standards).

  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 skills sets.

  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.

Tony Griffin

Director of Health Science and Manager of the School of Dental Care Professionals

December 2007





 
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