Dentists outraged as DoH refuses to play NICE

The Department of Health will not be seeking NICE guidance on the HTM 01-05 decontamination guidelines for dental surgeries, despite calls to do so from outraged dentists.

The National Institute for Clinical Excellence (NICE) develops national clinical guidelines to ‘secure consistent, high quality, evidence-based care for patients’.

Chief dental officer for England, Barry Cockcroft, maintains that, because hygiene regulations change with new scientific evidence, the document is not best suited to NICE assessment but promises: ‘I have made a commitment to review this guidance within the next two years to reflect emerging evidence.’

However, the British Dental Association (BDA) claims there is a need for clarity and says NICE would be the most appropriate body to carry out an evaluation.

The memorandum was first published on the DoH website in October 2008 and it’s hoped will ‘progressively raise the quality of decontamination within the primary care sector, giving options in terms of approach’.

The aim is that, initially, all practices will have to meet the HTM’s ‘essential quality requirements’ within a year of receiving the guidance, but ultimately practices will need to move towards best practice in time.

The guidance is being sent out to practices soon, but Dr Cockcroft acknowledged that it was difficult to set a timescale.

He explained: ‘The HTM 01-05 was first published on the DoH website October 2008. The BDA first asked for the publication of a list of evidence-based references October 2009 and a full list of references went out to the BDA on Monday [1 December 2009].

‘As our knowledge improves, we will constantly update it and, as we commission research, we can fill gaps in our knowledge. We are moving towards best practice and it is difficult to put a timescale on it. We want to improve quality of service and we need to see that practices are clearly demonstrating they are trying to improve quality of their processes.’

But a spokesman for the BDA said: ‘The BDA worked with the Department of Health on the development of the guidance, offering input on the practical implications it would have on dental practice. The BDA was assured that a firm evidence base was in place.

‘The strength of that evidence base was brought into question by the Department’s offer to publish it, then failure to do so when that offer was accepted.

‘The BDA’s concerns were exacerbated when, at the same time, it became apparent that a number of the standards in the document had changed between online publication and the version that was to go to print. These concerns led the BDA to believe that in the best interests of patients and dentists the evidence is fully evaluated. NICE would be the most appropriate body to carry out such an evaluation.’

In his letter to NHS dentists, Dr Cockcroft says that ‘all working drafts were shared with key stakeholders, including the British Dental Association and we have responded to any comments received.’

Looking ahead, he expects dental practice compliance to HTM 01-05 guidance should satisfy the ‘essential quality requirements’ around the decontamination of dental equipment and that the accompanying audit tool (in the form of a CD-rom) will be sent out, along with the guidance, to all NHS practices soon.

Discussing the costs to the dentist, he said that although many PCTs are making ‘significant investment’ he recognised that others ‘may not have such a good working relationship with DCPs’ and suggested dentists needed to ‘take interest’ in the regulations as will PCTs when commissioning services from practices.

The BDA agree with this and anticipates that the contribution of primary care trusts to meeting the cost of compliance will vary, the BDA anticipates. Where contributions are made by PCTs they are likely to be to initial capital funding. The ongoing costs, including staff, consumables and vitally time, will be borne solely by practice owners and will have far greater long-term impact on the viability of NHS dental practice.

The BDA spokesman added: ‘The requirements of HTM 01-05 increase the administrative burden on dentists considerably. The BDA does not assess compliance, but we have been contacted by significant numbers of dentists seeking advice on what the regulations will mean for their surgeries.’

He added that the cost of complying with HTM 01-05 is currently being analysed by the BDA.

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