Compare and contrast – do you remember those words in essay questions? Well I want to compare and contrast the Steele report with the Warburton contract in respect of having a list of patients. Both say that dentists should have lists of patients; both believe that
dentists should be paid for these patients. But there are fundamental differences in their approaches, which show that Warburton is only interested in getting as many patients as possible on to lists at the least cost to the detriment of both patients and dentists.
Steele recommends that patients should be registered in a ‘continuing care relationship’ with a practice that would give them an absolute right to return to that practice for both routine and urgent care. ‘Continuity of care matters to patients and to dentists,’ he says. ‘It is important in building a relationship of trust and a philosophy of lifelong care.’ But he also says that this implies responsibilities and rights on both sides.
There will clearly be obligations on both dentists and their registered patients. After an oral health assessment the dentist must offer a programme of care based on prevention and routine management. Patients, to enter continuing care, must accept this programme and the obligations to follow it and attend as advised.
Only if a patient is established in continuing care and their risks are managed, can they be considered for advanced care. Those who do not want to go down this path must be offered emergency care as required. A patient whose idea of ‘regular’ is to be seen once every five years and then demands to have ‘all my work done on the NHS’ will be disappointed. They will only be eligible for emergency care unless they sign up to a continuing care programme.
Contrast this with Warburton. Here everyone becomes a ‘regular patient’ once they have had a check-up. And they stay a ‘regular patient’ until they die or move on. Result: a massive increase in patients and ‘access’. Now comes the clever bit. Whereas with Steele (or our GP colleagues) you receive a capitation payment for all your registered patients, with Warburton you will only be paid if the patient is seen by you.
One wonders what the BMA would say if Warburton tried that trick on his GP colleagues. But from the BDA not a squeak of protest when he does it for dentists. Furthermore when our ‘regular’ patients return after five years, do they get told ‘urgent treatment only’? No, the red carpet is rolled out and you poor dentist must provide all the treatment for either three or 12 UDAs.
Isn’t it time the BDA told the secretary of state (not the CDO or a department official) that if he wants co-operation on Steele, then he needs to dispense with the services of Warburton?