Memorandum by the Patients Association
DENTAL SERVICES INQUIRY
PCTs are now able to devise sound commissioning
proposals for dentistry. Their dental services are now incorporated
into general NHS planning.
In respect of private sector dentists, and the
number of patients registering with them, the view of the Patients
Association is that we have seen a significant number of NHS and
private dentists who are now offering private care.
The reasons for this are not only increased
fees available privately, but the uncertainty over the renewal
of the contract in 2009. In turn this is because of problems in
achieving UDA's and whether or not a new contract will be forthcoming
in 2009. Dentists are increasing their percentage of private work
to ensure the viability of their practice. The contract with the
PCT cannot be re-negotiated or alternatively if they are negotiated
it will be on terms that affect the viability of their practice.
Patients have been grossly misled as to the
availability of NHS dentistry. Media coverage of lack of dentists,
confusion over the new contract terms, and the usual lack of information
to patients about changes have led to a generalized view that
there is no point in trying to access an NHS dentist.
This has not been helped by the fact that dentists
are allowed to do far more private treatment alongside the NHS
treatment than they used to do. A number of treatments available
under the NHS can now be offered privately without there being
a conflict with NHS care, and therefore patients are being offered
private treatment (and accepting it) whereas under the old rules,
the mixing of private and NHS treatment was far more difficult.
This former point of principle may have ramifications for other
This acceptance of patients having private treatment
makes the conversion of an NHS patient to a private patient much
easier, and puts the NHS patient in a mindset where they feel
that part of the treatment is not available under the NHS scheme.
They feel they are being converted to private patients by a back
In respect of the work of allied professions
patients need assurance of the competence of technicians, providing
dentures, traditionally the preserve of dentists, as they move
to offering more complex forms of treatment. Patients will need
the assurance that conditions which the technicians work under
are of the same standard as dental surgeries ie problems with
sterility, and appropriate clinical vetting.
In respect of patients access to NHS dental
care, the Patients Association has had a number of calls to their
helpline relating to the difficulty of obtaining NHS dental treatment
in three specific areas:
2. Specific treatmentsorthodontics,
root canal. The contract has excluded care by stealth.
3. Uncertainty over charges leading to a
patient withdrawing from dental care all together.
If the contract does not allow for time for
preventative care and advice there is a real danger of higher
cost to patients, clinically and financially in the longer term.
The dentist remains the main point of advice on oral health.
NHS DENTAL PRACTITIONERS
Unless dentistry is a financially attractive
proposition it follows that there will be a shortage of NHS dentists
from Britain or overseas. Without ring fenced funding PCTs will
be unable to deliver the dental service required.
The public health responsibility of PCTs is
made more difficult because of the variations in fluoridation
levels of the water supply. This means in effect that the demands
on PCT budgets varies according to the level of dental caries
in their populations which directly relates to the level of fluoride
in their local water supply. The Water Act 2003 gave the right
to decide on water fluoridations in local communities. This variation
in dental health is another example of the postcode lottery for
19 December 2007