The evolution of NHS dental care – what are the lessons?

Terry Jones I am a Norfolk based dentist, work at an IDH practice, and the views on this blog are my own. It is the first of a series of blogs.

Primary care contracts for dental care have evolved and changed over the past 60 years, and I have been part of this story. The question for the practitioners and the country is what are the lessons and how do we move forward. The greatest change occurred only 3 years after the inception of the NHS, when in 1951 dental charges were introduced, separating us from our medical colleagues in spirit, and the great post war dream of free care for those in need of treatment. Anuerin Bevan quickly realised that the Health service would require increasing funding and he conceded that the service would always be in crisis over this issue. He pragmatically advised that those who wish to have gold in their teeth should pay, today’s gold is Titanium! The model of fee for item service became an unsustainable burden for practitioners, the treadmill was spinning too fast, and the Department of Health looked for control of the ever increasing costs. The resulting contract of 2006 and the universally derided UDA system was the result. On reflection this should not have been a great surprise. Each contract revision apart from 1990 has resulted in a tightening of the fiscal belt. The claw back of 1992 led to many seeking remuneration from the private sector, where at least the clinician exerted control of their fees. Lots of time has been taken with the present pilots, it is an indication that a lot of thought is going into our future. This is to be commended, but past experience should make us wary. This is my belief, and should not cause us too much concern. The principal concern we should have is the contract between us and the patient. Those able, caring, and ethical practitioners have prospered well under each and every contract modification. For those who are less caring, able and ethical life has been more problematic, and we each can think of examples of such individuals. The recent scandal unfolding in Nottingham was not caused by the perceived poor UDA contract. We are self employed contractors and it is for each of us to give a good account of ourselves. The increasing burden of regulation that we and others suffer is becoming a barrier to our contract between us and our patients. Anything that reduces the burden of management should be given consideration, and I believe is one of the reasons for the rise of the corporates. I have experience of a large dental corporate and I am impressed with their high standards in clinical governance, and thereby patient care. They are not altruistic, but this can be managed with effective contractual agreement, if the corporate wish to have NHS contracts. Relieved of all things management and financial, more time can be devoted to the patient and equally to us and our families- dentists are clinicians, not business managers. So, where do we go from here? I believe we should be imaginative and brave enough to meet the challenges of the new financial and management realities and the changing demographics - the corporate model might be the way forward, it has different versions, including shared ownership. Have your say