Everybody wants the Steele report recommendations to be piloted, especially Professor Jimmy
himself. Speaking to the All Party Parliamentary Group for Dentistry, he stressed the importance of openness and innovation in taking forward his team’s proposals and underlined the importance of proper piloting to effective reforms. Welcoming the report back in June, John Milne, who chairs the General Dental Practice Committee, stressed the importance of the government piloting the changes properly.
The Steele report recommended that the development of contracts, with incentives to reward continuing care, activity and quality, should be developed via centrally managed pilots which would be ‘robustly evaluated’. He continued: ‘The pilots need to be robust and to be given sufficient time to settle, helping to understand how dentists, patients and PCTs react and giving time for that knowledge to be synthesised before wholesale changes are considered.’
What I have been hearing since Steele reported, especially at a meeting of the Westminster Forum on 22 July, suggests that these basic principles may not be met. The Department of Health (DH) has an access team, led by Dr Mike Warburton, which is developing a contract for the procurement of new services. This process will be used to pilot some of the ‘key components’ of Steele’s recommendations.
When this new contract was mentioned at the Westminster Forum, everyone wanted to know what was in it. We were told that a draft had been shared with the British Dental Association and discussions would take place. The other members of the Steele review had also seen it. In fact, I came to the conclusion that the only people who hadn’t seen it were the dentists who will have to work under it.
At the same time, the chief dental officer has written to all dentists telling them about the Steele report and asking for expressions of interest for these pilots. He has received a large volume of replies. It seems that anyone can set up their own pilot. But they are supposed, after evaluation, to set national guidelines which will apply to all dental contracts. It seems a recipe for chaos and confusion.
When looking at the reaction of dentists towards the introduction of the contract in 2006, Steele said that they were ‘suspicious of government motives towards NHS dentistry’. In particular, he said that this suspicion was not helped when some of the aspects of the reforms were introduced without proper piloting. The lack of openness and the confusion about the new pilots does not bode well for the changes to be accepted by the dentists who will have to deliver the service.