A recipe for disaster?

Jimmy Steele’s review seems to be going well at present. His team seems not only to understand the problems facing the government over the contract and the critical Health Select Committee report, but also take a genuine interest in dentists’ thoughts and concerns.

I am sure when his report comes out in June it will not be to everyone’s taste, because he has a tricky path to walk between the hopes of dentists, the wishes of the government and, most importantly, the needs of patients. He will not be able to please everyone – the trick is to produce a report that will lead to action, not the electronic equivalent of gathering dust on a shelf.
At the same time as the Steele review was set up, the government appointed Dr Mike Warburton to run a national dental access programme. Last year he ran a GP access programme resulting in extended opening hours and additional services being provided. He has set up a dental access programme website instituting a so-called PCT procurement framework.

All good stuff if you are a NHS dental manager, which most readers of Dentistry are not. What seems to be absent is the sort of engagement with the profession that is characteristic of the Jimmy Steele approach. Nor is there any appreciation of the extent to which NHS dentistry is funded by patients through charges. The key questions are: 1. Why are dentists not taking on patients who are new to the practice? 2. Why are some patients not coming for treatment even when services are available?

To the first question, the answer may well be that there is too greater financial risk in doing this within a rigidly constrained UDA system. The solution is to change the system – as Jimmy Steele is considering. To the second, that the NHS charges are too high, or there simply isn’t the demand that everyone thought was there, or patients prefer to stay with their dentist when he or she converts to the private sector.

Mike Warburton’s reported solutions appear to include extending opening hours as he did with GPs. This will do little good unless dentists are prepared to take on more new patients, which, without a change, in system is unlikely. He also appears to want to have fixed-term PDS contracts for new services, lower UDA values and payments for quality. But isn’t all that what Jimmy Steele’s team is looking at? It looks like another recipe for chaos.

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