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.
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