Seasons of mist

The march of the seasons is upon us and, as a consequence of a late summer holiday, I have come back to find the trees turning brown – although the weather is now doing what it should have done about two months ago.

The change of the seasons also reminds us that it is now more than three months since Professor Steele delivered his report on developing NHS dentistry, which was accepted by the government ‘in principle’.

So more than half of the time period (six months) within which some of the first fruits of this report should have been seen has now elapsed. Speaking at the Key Stakeholder Group meeting in June, the CDO said that pilots were intended to start in the autumn…

So here we are, it’s officially autumn and the only change has been that the days are shortening, and the word ‘Steele’ has been replaced by the word ‘Warburton’ in most articles on the future of NHS dentistry, a fact, incidentally, I predicted earlier in the year.

The current view from the Department is that the Warburton access contract is still only in draft form and the implication is that PCTs using it for the new access pilots which have been advertised over the summer in the BDJ and elsewhere have somehow jumped the gun. This was clearly not Dr Warburton’s intent, when he wrote, at the end of August: ‘The DAP [Dental Access Programme] template contract has now progressed significantly and is undergoing internal and external stakeholder reviews and consultation. We are happy to trial it with PCTs requiring a new contract as part of their local procurements ahead of wider release on the website and are already working with ten frontrunner PCTs on this basis. If you are interested in joining them, please contact the DH commercial team.’ [1]

So I remain as confused as anyone when trying to understand how these proposals are going to be integrated into the new targets for achieving millions more patient registrations by the end of the financial year, while still piloting Professor Steele’s ideas. It is indeed a misty time.
Meanwhile we still await the production of HTM 01-05, which is now a year old since its first appearance on the DH (England) website in draft form. Unlike the promises about the access contract, this document has become even more complex and wordy since first seen.
While I know that many believe that the basis of HTM is financially impractical, there is also the need to ensure that practitioners are aware of its implications since PCTs and, no doubt, the Care Quality Commission will accept that it is the law and compliance is not optional.

I do hope that some sanity prevails and that an intelligent review can be initiated (as opposed to blind opposition) to remove the parts which are non-evidence based and which have no clear possibility of creating a safer environment for ourselves, our teams and our patients.
Surprisingly, no one has yet pointed out to me the most prominent absurdity – that of having two discrete infection control standards in England (and Wales): ‘Would you like your heart by-pass done in the clean operating theatre, or the really clean one, Mr Bloggs?’ But I guess it was a way of getting around the Scottish Problem, which is, bluntly, that only a minority of practices would achieve the higher standard in the short term.

It may be autumn here, but it’s spring in New Zealand. Fancy a relocation, anyone?

[1] See

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