Derek Pearson, executive editor Dental Practice and The Dental Technician

AS the editor of two dental titles I hear a lot of comment around the subject of how the new NHS contracts will evolve, including questions about the efficacy of the pilot schemes, which now involve nearly 100 practices.

The Department of Health has taken a cautious approach towards fashioning the final contract model to be rolled out across the profession. Key words issued by the DoH seem to circle around the need for robust evidence about how the pilots are working and quantifiable parameters for identifying successful dental care.

These would seem to be the current stumbling blocks: How can we measure successful outcomes in preventive dentistry? What measurable criteria do we use to remunerate dentists for what is seen by some as work avoidance?

The new pilots would seem to follow the ancient Chinese adage: “One should only pay one’s doctor when one is well.” According to talk in the profession there is a problem with such an approach in that some patients are patently incapable of following an oral hygiene regime. Must the dentist be held accountable for patients’ failings?

Some quite vocal observers fear preventive care may, in some cases, lead to the creation of a “culture of supervised neglect”. However, such fears would seem to fly in the face of comments coming from those involved with the pilots to date. What we hear from the DoH is that dentists are reported to be relieved and happy to step off the UDA treadmill and once more provide the levels of care they were trained for as undergraduates. And patients feel better cared for and happier in the surgery, meaning the new contract systems would appear to be on the point of becoming a win-win situation all round once its final details have been hammered into place. Is that really the case?

I also hear a lot of resistance against mooted changes to the dental team’s scope of practice, which will, if implemented, allow greater responsibility to rest on the shoulders of non-clinical dental care professionals such as therapists and hygienists. A triage approach to dental care, by which DCPs see patients first and then refer up the food chain if they find cause, would, at first sight, seem a good idea. Others are just as certain it isn’t.

Not every practice has a therapist nor do they all have hygienists, but surely if the personnel are available full use should be made of them? The DoH is talking about changes to training for DCPs in line with this triage approach, which will save money, take the load off dentists so they can get on with more complex treatments and lessen the financial burden for the patients. What’s not to like?

Financially there is the dental remuneration debate – capitation over UDAs – wow, such a clouded subject. Some people love UDAs and others act as if they are the work of the devil. They can be gamed, abused and create clawback if the practice fails to meet targets. Surely UDAs have reached their use-by date and capitation should be used at the point of demand? Then what about those observers who feel capitation is just another route towards bringing private practice systems in to replace Government funding for the NHS? I wonder.

I would love to hear what members of the dental team are really expecting from the new contract once the “robust” evidence is finally in and the dust covers come off its ultimate incarnation? What are you hoping for and what do you think you will get? I’d love to know.