Memorandum by The British Association
for the Study of Community Dentistry [BASCD] (DS29)
BASCD is an alliance of individuals with an
interest in population oral health, working together to:
Provide a set of principles for the
improvement of oral health and the development of oral health
care and promote their dissemination.
Influence policy at international,
national, regional and local level in support of oral health.
Members work in dental public health, primary
and hospital dental care (particularly community and special care
dentistry) and beyond. Our evidence relates to the following four
I. The role of Primary Care Trusts in commissioning
II. Patients' access to NHS dental care.
III. The quality of care provided to patients,
which must involve prevention.
IV. The extent to which dentists are encouraged
to provide preventive care and advice.
The Association has been involved directly or
through its members in developing, and implementing, key guidance,
in support of recent dental policy changes and the promotion of
oral health particular, as outlined below.
1. Members of the Association play an important
role within Primary Care Trusts [PCTs] and Strategic Health Authorities
as advisors on commissioning of dental services. However, with
recent management reorganisations there has been a significant
reduction in service capacity. There are therefore serious pressures
on the capacity of Dental Public Health specialists to deliver
sufficient dental public health support to NHS organisations at
a time when the expertise is clearly required to support the new
commissioning powers of PCTs. The lack of Dental Public Health
advice in some PCTS is a problem.
2. This reduction of capacity, in both the
NHS and academia, has been recognised by the Department of Health.
Within England there is currently a Review of Dental Public Health
capacity and capability. This Association, welcomes this review
and considers it vitally important that there should be sufficient
specialist expertise at local and strategic levels to ensure that
there is effective needs-led commissioning of dental care, both
treatment and preventive.
3. In recognition that commissioning of
dental care should relate to local need, members of this association
have worked with Primary Care Contracting in developing a needs
assessment toolkit to assist with assessing need at Primary Care
Trust levels. This is not a one-off process but requires work
to inform commissioners on an ongoing basis on all aspects of
oral and dental care. Members of BASCD have been involved in national
events and workshops in shaping policy, commissioning and service
redesign to support needs-led commissioning.
4. This Association through its Information
Section has played, and continues to play, a major role in oral
health surveillance through the coordination of local epidemiological
surveys. This includes quality assuring the programme. This
information is important to inform needs-led commissioning as
outlined above. In addition to local surveys, the comparative
information on national trends from national surveys is vitally
important. As an association we are concerned that the Adult Dental
Health Survey for 2008 has not yet been commissioned. This would
have been the third UK survey and the fourth decennial survey
for England. We urge that this national survey takes place as
soon as possible as it provides national and regional information
on adult oral health in the population.
TO NHS DENTAL
5. Access to dental care is an important
public health issue for all sections of society. NICE dental recall
guidance suggests that adults should attend at least once every
two years and children every year, with more frequent checkups
based on their level of risk. Current levels of uptake of dental
care are in the region of 70.7% for children and 50.5% for adults
in England; and thus while a proportion of adults attend for
private dental care, there is still a significant section of the
population who is not accessing care regularly (within a 24 month
period). Many of these groups will require care to be provided
in modern delivery systems as outlined by Lord Darzi, which
involves the development of primary care centres with extended
opening hours and outreach facilities.
6. It is particularly important to ensure
that in a market based health economy, that vulnerable groups
in society do not miss out on receiving dental care and thus result
in an increase in inequalities in health. This is particularly
important when many vulnerable groups in society, such as older
people, are not exempt from patient charges in England. Furthermore,
people with high oral health needs are not supported in receiving
care under the new system. Members of the association have been
involved in the recent guidance on Valuing People's Oral Health,
which highlights the importance of promoting oral health in people
with learning disabilities.
7. For many BASCD members their area of
clinical practice is in special care dentistry. They face daily
the challenges and complexities of providing dental care for this
client group. For many such patients the complexity of needs,
even to enable the simplest dentistry to be performed, is considerable.
BASCD members have worked with representatives of the BDA Central
Committee for Community and Public Health Dentistry to develop
a model which describes such complexities. This model, known as
the "casemix toolkit" is now beginning to be used in
many salaried dental services throughout the country. The model,
which will be formally launched in January 2008, enables both
providers and commissioners to better understand these needs and
provide appropriate services to meet them.
8. Individuals from this Association are
also leading and contributing to a review of Black and Minority
Ethnic populations in relation to primary dental care for the
Department of Health. Collection of ethnicity data as part of
routine primary dental care information systems will be important
to support this initiative.
9. The quality of care accessed is important.
One feature of quality which this association supports proactively
is health promotion as outlined by the range of activities in
which the Association, or members of BASCD as individuals, have
led or been involved in a range of important initiatives in support
of Standards for Better Health.
10. Information on the nature of care provided
and how this relates to oral health needs and risk of disease
should be collected in future at practice level to provide an
indication of the "appropriateness" and therefore "quality"
11. Members of the Association have supported
dentists with a special interest in Prison Dentistry to develop
support networks and quality initiatives in support of oral healthcare
amongst this needy section of the population.
12. Working with the Department of Health
and other key stakeholders, members of this association have assisted
with the development of a range of health promotion initiatives
Oral Health Promotion toolkitDelivering
Better Oral Health
These are very important initiatives in supporting
health promoting oral and dental care in line with contemporary
evidence. The "toolkit" is currently being distributed
to all dentists and requires a series of actions to support its
implementation from education through to remuneration.
13. It is of great concern to this Association
that there is nothing in the current dental contract to encourage
dentists to provide preventive care and advice. A reorientation
of dental services to promote oral health and prevent oral diseases
in an evidence-based manner is the only way to play a major contribution
to the public and patients in the long-term. In promoting this
approach, the Association recognises the important work of Sir
Derek Wanless[10,11], and the more recent work of Lord Darzi
which supports "staying healthy". This must be addressed
in future dental policy. Members of BASCD are also working on
a "Commissioning for Oral Health" self-assessment toolkit
to support PCTs assess competence in this role and identify areas
for improvement by describing and sharing excellence.
14. Prevention must not be limited to attendees
of dental services but of necessity must focus on the whole population.
Resources are therefore required to support public health programmes
at population level.
15. In considering the size of the dental
workforce, merely considering numbers of dentists, and dentist
to population ratios is not sufficient unless the "whole
time equivalent" is considered. Such data are currently not
16. To date, the new contract does not seem
to provide a direct incentive for the use of skill-mix to extend
the workforce. In future there should be greater emphasis on team-working
and skill-mix maximisation, as many of the tasks in primary dental
care could be undertaken by hygienists and therapists working
with dentists. Individuals from this society have contributed
to workforce planning projects and a national toolkit resource.
Dr Liana Zoitopoulos
Secretary of BASCD
1. Primary Care Contracting: Oral health needs
assessment toolkit for primary care trusts. London: Primary Care
2. BASCD: The Information Section [http://www.bascd.org/info_home.php]
3. NICE: Dental recall guidelines. National Institute
for Health and Clinical Excellence; 2004.
4. The Information Centre: Primary dental care
data, 30 July 2007 http://www.ic.nhs.uk/statistics-and-data-collections/primary-care/dentistry/nhs-dental-statistics-q1-2007-08
5. Darzi A: Our NHS Our Future. London: Department
of Health; 2007
6. Department of Health: Valuing People's Oral
Health: A good practice guide for improving the oral health of
disabled children and adults. Department of Health; 2007
7. Department of Health: Guidelines for the appointment
of Dentists with Special Interests in Prison Dentistry. London:
Department of Health; 2007
8. Department of Health: Delivering better oral
health: An evidence-based toolkit for prevention. London: Department
of Health and British Association for the Study of Community Dentistry;
9. Department of Health: Smoke free and smiling.
London: Department of Health; 2007
10. Wanless, D: Securing good health for the
whole population: final report. London: HMSO; 2004.
11. Wanless, D: Securing our future health: taking
a long-term view. London: HMSO; 2002.
12. National Workforce Resource: National Workforce
Projects: Dental Workforce Resource Pack. Manchester: NHS National
Workforce Projects; 2007