While I was reading a copy of the Steele Report, phrases such as ‘patient pathway’, ‘oral health assessment’ and ‘clinical guidelines’ rang a bell. I had been writing them nearly 10 years ago while helping to draft the Options for Change report.
Indeed Jimmy Steele acknowledges that several of his recommendations have appeared in previous reviews. But Personal Dental Services (PDS) pilots, which arose from Options for Change, were summarily abandoned and were never translated into the 2006 contract.
Professor Steele does not recommend the end of local commissioning; he wants the standard to be raised to the level of the best primary care trusts (PCTs).
He says that there must be some measure of activity, which means that units of dental activity (UDAs) will remain, albeit having been reformed. They will not though, as now, be the sole currency of the contract, which must in future acknowledge numbers of patients on your ‘list’ as well as quality measures.
The proposed patient pathway has three elements. Everyone is entitled to urgent care when needed and be given pain relief. Those patients who want routine care will receive an oral health assessment and prevention, then be accepted as a patient of the practice for routine continuity of care. Advanced care, such as most band 3 treatments and molar endodontics, will be provided only where there is a ‘stable oral environment’ and be commissioned (and paid for) separately from selected dentists.
There is a fundamental change in philosophy here. Most reviews, since the Tattersall Committee (1964), have advocated a system where patients are brought into maintenance once they have been made dentally fit, which may involve complex work.
Under Steele, they will be brought into maintenance before and as a pre-condition of their having complex work. This signals the end of the concept of dental fitness, which many feel is outmoded.
PCTs will have to commission more than UDAs. They will have to commission high-class services, which may come as a surprise to some. This tallies with a requirement for dentists to guarantee their work for three years. Questioned about this at his press conference, Professor Steele said that no dentist should use a handpiece on a tooth unless they were reasonably certain of the long-term outcome.
The report seems to tick many of the right boxes for dentists and patients but, as Jimmy Steele says, while it may be relatively easy to ‘set out a vision’, achieving change is much more difficult. Change will be piloted, but so was the last one through PDS.
When patient charge revenue declined however, the Treasury pulled the plug on it. It will be a tragedy if the same fate awaits this latest review.