Tariq Drabu Dentist Funding Rise Disappoints

The Department of Health in England have recently announced that will award NHS general dental practitioners in England an uplift on their funding of just 1.5 per cent for the year 2013/14.

We are not just dentists we are also responsible members of society and we realise that public finances are tight. As dentists we understand that difficult choices have to be made but we also have to look at our ever increasing cost base in the face of a static income stream from the NHS. Water, gas and electricity for example are amongst the items that have increased way beyond the level of inflation over the past two years. There is also an increased burden and cost implication of tighter and more stringent regulation from bodies such as the Care Quality Commission (CQC). These increasing expenses eat in to our cost base and therefore will eventually have a direct impact on patient care.

This month sees the biggest shake up in health care in England since 1948 and it is a time of major uncertainty for dentists. Local arrangements, whereby dentistry was commissioned by Primary Care Trusts, have been abolished and replaced by arrangements with the National Commissioning Board based in Leeds and London. At the moment, we do not know which personnel we are dealing with and what their remit is. Allied to that, we face the prospect of a new dental contract in 2015 about which few details are as yet known except that it is to be based on capitation, registration and quality. There is no detail about how this contract is to be delivered and by whom.

NHS dental charges have gone up for the three bands of treatment. A band 1 has gone up from £17.50 to £18.00, a band 2 from £48.00 to £49.00 and a band 3 from £209 to £214. Dentists act as unpaid tax collectors for the government and if patients don’t pay we end up holding the bad debt. This is a very unfair state of affairs and one which is not replicated in any other aspect of direct health care.

I am proud to come from a family who have worked and served the NHS since the 1950s. In 1998, when I bought Langley Dental Practice it was a very run down premises but I bought it because I wanted to make a difference to people’s lives. In 2005, the practice underwent a total rebuild and refurbishment - a project that took 6 months. Support for this expansion came from local MP Jim Dobbin and the then Minister at the Department of Health Rosie Winterton MP, both of whom personally visited the practice to show support. I invested more than £350,000 to secure the rebuild and improve dental services for the residents of Middleton. The practice more than tripled in size and expanded from 2 to 4 chairs. High tech dedicated cross infection areas and modern brand new dental equipment were installed. When the practice reopened in October 2005 it was featured in both local and national press and on TV. Our patient base has expanded from 1500 back in 1998 to nearly 20000 now.

I am also wary of the further stipulations and conditions put forward by the Department of Health (DoH) around future contract management which lack detail. The DoH have announced that dentists will be expected to continue to work closely with the them and the NHS Commissioning Board to prepare for moves to a national contract based on capitation, quality and registration; there is also mention of a further move to fully computerised practice systems and a nationally consistent approach to contract management. The package mentions changes to the way the NHS will manage dental contracts at the end of the 13/14 financial year and new ways to ensure more appropriate patterns of referral between dentists both within primary care and to acute services. There is no detail about these measures as yet and we need to see what is being proposed. Our aim as dentists should be to do the best for our patients and be able to work with a contract that puts oral health at the front of the agenda and delivers a workable quality based system of remuneration. I hope that these changes can lead to this.

Dr Tariq Drabu Affair Around Dental Access

The latest set of statistical figures produced by the NHS which show an overall increase in NHS dental access but still have some numbers that prompt concern. 
The most recent report from the NHS is the latest in a series of quarterly reports published by the NHS that brings together information on NHS dental activity in England up to the second quarter of 2012/13 and also provides information on the number of patients seen by an NHS dentist, up to the third quarter of 2012/13. One of the key headline figures is that a total of 29.7 million patients were seen in the 24 month period ending December 2012, an increase of 1.5 million on the March 2006 baseline date when the last dental contract was introduced. However although this may seem like a large number if one looks a little deeper one can see that this represents 56.0 per cent of the population compared with the March 2006 figure of 55.8 per cent. This is a very small increase.
However, looking at it from another angle, it shows that the 29.7 million figure is an increase of 135,000 patients on the previous quarter and a rise of 265,000 on the same quarter in 2011-12. The total number of patients seen has increased each quarter since its lowest point in June 2008. In December 2009 the number exceeded the March 2006 baseline, when the current dental contract was introduced. So overall the news is positive in terms of raw numbers, however there remains a massive amount of work to be done to get a larger proportion of the population to access NHS dentistry.
It is disappointing to note that the number of children seen by an NHS dentist is equal to the March 2006 base figure of 7.8 million; however what is of more concern is that the percentage of children seen (69.0 per cent) is below the 2006 base figure (70.7 per cent). When the coalition government came to power in May 2010 they promised to make the dental health of children a priority and I seems that they have not been able to deliver on this. Child dental health is important.
Here in North Manchester, we practice in an area of high social deprivation and poor dental health. In terms of tooth decay levels, our local health trusts are in the bottom 20 out of all 300 health trusts in the whole country. Figures from the Department of Health show that areas like ours have children's tooth decay rates that are eight times worse than the best areas in the country. As such, we need prompt and proactive public health measures such as water fluoridation in order to improve the dental health of the population, especially children. A comparable area like South Birmingham, which is in the bottom third for social deprivation but which has fluoride in the water, is in the top third of areas with the lowest levels of tooth decay. So, when we compare like for like we can see that fluoride does work.
The amount of treatment appears being undertaken appears to be less There were an estimated 9.9 million Courses of Treatment (CoTs) in the second quarter of 2012/13, a decrease of 118 thousand (1.2 per cent) on the same period in 2011/12. All treatment bands saw a decrease in the second quarter of 2012/13 compared with the same quarter in 2011/12. These figures may indicate an increasing move towards prevention.
I find it both sad and amusing that an MP from the Labour Party, which abolished dental registration in 2006, who has dentistry as his brief, has actually tabled a parliamentary question asking about the number of registered dental patients. This just shows a woeful and inadequate level of understanding.
There are lies, damned lies and statistics. It is easy to look at headline figures, but any set of statistics need deeper analysis and reflection. They can be viewed from many angles and seized upon by people with different agenda to satisfy their political needs. The good news is that more patients are being seen but the figures are a mixed bag.

Tariq Drabu Affair on Public Health and Flouride

Recent dental news revealed that in Wales more than four in 10 children are suffering tooth decay by the age of just five, according to figures released today by the Welsh Government. These worrying figures came to light last month just as the Government launched its National Oral Health plan, which aims to tackle dental problems in children. Tooth decay is a preventable disease and it is a well known fact that getting fluoride in to contact with teeth will have a positive effect on dental health. The best ways of doing this is by Fluoridation of the public water supply.

With the abolition of Primary Care Trusts responsible for local health provision after 1st April these current NHS reorganisations may lead to moves towards public water fluoridation being missed and in some cases abandoned, leading to a deterioration in the dental health of the population, especially children.

Last year there was confusion surrounding the proposed fluoridation of water in Southampton. In early 2012, the South of England Strategic Health Authority, which is due to be abolished in April 2013, insisted that fluoridation was due to go ahead in Southampton. However, from April 2013 the decision for fluoridation was to be passed to the local council. The council itself has already voted against the measure. The current understanding is that now, in a move that makes matters even more confusing, Southampton city council will await the outcome of a government consultation before deciding if they will consult residents on whether the fluoridation scheme should go ahead or be stopped. If the Southampton situation is reproduced all over the country where nobody knows what is going on then we are heading for a complete and utter mess. The current state of affairs is ambiguous, uncertain and muddled and it must be reviewed.

We practice here in North Manchester, which is an area of high social deprivation and poor dental health. In terms of tooth decay levels, our local health trusts are in the bottom 20 out of all 300 health trusts in the whole country. Figures from the Department of Health show that areas like ours have children's tooth decay rates that are eight times worse than the best areas in the country. Therefore we need prompt and proactive public health measures such as water fluoridation in order to improve the dental health of the population, especially children. A comparable area like South Birmingham, which is in the bottom third for social deprivation but which has fluoride in the water, is in the top third of areas with the lowest levels of tooth decay. So, when we compare like for like we can see that fluoride does work.

Back in 2010 after the election the Coalition government in its flagship "Programme for Government" document said not only that it would introduce a new NHS dentistry contract but more importantly it talked about an additional focus on the oral health of schoolchildren. The new contract is making ground but the dental public health of children is falling by the wayside and the confusion surrounding fluoridation will only make matters worse.

We need a strong lead from government to get fluoridation back on the agenda. The government talks a lot about reducing health inequalities. It needs to show that it is serious. It can show that it is serious by pushing forward with a programme of water Fluoridation.