In the recent CDO Update, Barry Cockcroft wrote: ‘In a service that is now commissioned by PCTs, it is important that clinicians play an important part, not only in providing services, but also in working with PCTs to develop services.’
1 April 2009 is often spoken of as the date when local contracting ends and local commissioning starts. The CDO added that he was now finding many examples of ‘local dentists working with their PCTs to develop services for everyone’s benefit’.
When Sue Gregory was appointed as deputy CDO, she said: ‘Although the transition process (setting up the new contract) was very rigid, the contract is actually very flexible. There is a challenge to achieve improved access and improved services and outcomes to patients and some PCTs are utilising the contract flexibility to achieve this. Although it is starting to happen now, it is clearly not happening quickly enough or widely enough and we need to get both sides to understand that and work together.’
In the early years of the contract, Units of Dental Activity (UDAs) were the only targets. PCTs were led to believe that provided they commissioned sufficient UDAs, they would achieve their goals of better access to services and improved oral health. The Health Select Committee, however, identified patchy access to dentistry in some parts of the country and declining rates of complex treatments.
The government has therefore set up a review – under Professor Jimmy Steele – to address the problem of uneven provision. It is likely that, as a result of this review, PCTs will have to get a lot smarter about commissioning, instead of just relying on UDAs alone.
To some extent, this has already started. When the government announced extra funding for the current financial year, it was to improve access to NHS dentistry. PCTs have
therefore been attaching conditions to extra UDAs such as the dentist agreeing to take on a certain number of patients who have not been seen in the preceding two years.
In Bradford, pre-school children, living in areas of high deprivation with poor levels of oral health, are to take part in a new fluoride varnish scheme in a pilot project by the PCT. A new strategy, with the focus of preventing dental problems among children, is to be introduced in Sheffield. Dentists in the city will be asked to sign a new contract that will encourage them to carry out more preventive work.
Therefore, expect later this year for PCTs to try to work with local dentists to improve the way they commission services. However, for them to be successful, they will need to adopt a more co-operative attitude towards the profession. After all, it is the dentist – not the PCT manager – who has the ability to improve access and oral health.