WESTERN CHESHIRE PRIMARY CARE TRUST
1. The role of Primary Care Trusts in Commissioning
Western Cheshire Primary Care Trust
had worked closely with its Dental Contractors in the years leading
up to the new contract. Most of the major service providers had
been working under Personal Dental Service Contracts following
the principles established in the Ellesmere Port Pilot in 1999.
There was therefore an established team with a clear understanding
with regard to how dental services worked. The contractors had
been working with the Primary Care Trust for two years to achieve
the objectives which would meet patient needs around access and
quality of service.
2. Numbers of NHS dentists and numbers of
patients registered with them
As detailed above the work carried
out prior to the new contract identified any areas where dental
services were at risk including those from practices intending
to "privatise" rather than accept the new contract.
The PCT was therefore able to anticipate any problem and investigate
situations prior to them occurring. The result was that any withdrawals
from the NHS were rapidly met by practitioners who had already
identified their willingness to expand. The Primary Care Trust
therefore was able to contract for more service than the previous
year contracting with an increased number of whole time equivalent
dentists. Dental Practice Board statistics identified that 84%
of children and 65% of adults living within Primary Care Trust
boundaries were treated during the year 06/07 confirming services
had been maintained.
3. The number of private sector dentists and
the number of patients registered with them
The private sector has remained much
as it was prior to the new contract. The majority who treat adults
privately but requested children only contracts have been accommodated
but with contracts restricted to 12 months. These contracts will
be expected to reduce annually as an increasing number of patients
take advantage of the access available in our practices.
The Primary Care Trust's aim is to
ensure that patients are not forced to accept private treatment
due to a lack of NHS provision. It is confident that all its residents
can be found an NHS dentist when they need treatment.
4. The work of allied professions
In order to take full advantage of
the benefits of team working it is necessary to have the benefits
of a larger scale operation. The Primary Care Trust has encouraged
practices to expand to ensure that they will be of a size to take
advantage of Professions Complimentary to Dentistry. Several projects
are being promoted using capital grants to assist practices to
achieve the required growth and become training practices of the
5. Patients access to NHS dental care
The UDA rate is crucial to the successful
commissioning of dental services. The Primary Care Trust entered
into negotiations with practitioners on the basis that the UDA
payment rates agreed would be at a level fair to the practice
and to the Primary Care Trust's responsibility to provide access.
The result has been guaranteed access for any resident of the
Primary Care Trust.
Access for fee paying adults has
an additional affect on patient charges. Low access means low
Patient Charges, good access means high Patient Charges. Access
and Patient Charges are therefore closely linked and a high UDA
rate results in less activity and therefore less access it will
be the fee paying adults who miss out and the Primary Care Trust
left with Patient Charge shortfall.
6. The quality of care provided to patients
The Primary Care Trust took part
in the pilot scheme of Dental Reference Officer visits which confirmed
the high standards being met by practices. This is partly as a
consequence of the established Peer Review Groups led by the Primary
Care Trust dental adviser over several years. The patients' survey
carried out at the end of the 1st year confirms the patient's
positive view of the services being provided.
7. The extent to which dentists are encouraged
to provide preventative care and advice
The Primary Care Trust has now established
a new Oral Health Plan, and will be working with contractors through
the Peer Review Groups to implement Primary Care Trust policy.
Only one contractor has a GDS contract and the rest work under
a PDS contract which will ensure they work with the Primary Care
Trust to implement the Oral Health Plan.
8. Dentists' workloads and incomes
The Primary Care Trust does not have
information on these areas but there is little evidence that they
have either received any additional bonus in either increased
income or a reduced workload.
This is implicit in good contracting
to ensure the same levels of activity are maintained and that
benefits are only achieved by working differently.
9. The recruitment and retention of NHS dental
The Primary Care Trust has not noticed
any real change in the movement of dental personnel. Despite the
challenging UDA rates the contractors have been able to recruit
to posts when they have become vacant.
Western Cheshire Primary Care Trust has found
the last three years to be very challenging with regard to implementing
the new contract. It has benefited from keeping together an experienced
dental team who have been able to commission services in a robust
but fair manner. This has benefited the Primary Care Trust, the
practitioners and most importantly the patients.
It is now moving forward with its contractors
to develop dental services to meet the requirements of its population
and to ensure that access for dental care is available for all.