Dentists caution on becoming mutuals

Dentists are likely to tread cautiously before joining David Cameron’s ‘Big Society’ by delivering care as ‘mutuals’ – outside the NHS.

Health secretary, Andrew Lansley, announced a £10 million expansion of existing plans for healthcare staff to ‘become their own bosses’, agreeing contracts with the NHS as social enterprises.

The ‘Right to Provide’ was a key plank of the drive to make the health service more ‘responsive to patients’, removing rules and targets that stifled energy and ambition, Mr Lansley said.

He added: ‘We’re giving staff greater control of their organisations. By handing responsibility and power to the frontline, a variety of services will develop, which in turn will give patients a real choice about the kind of care they want to receive.’

Last year, two projects involving dentistry – in Sheffield and in Torbay – were among 32 schemes given the go-ahead, but Mr Lansley hopes to trigger much greater interest.

Mutuals will run their own budget, lease NHS equipment and the premises where they provide treatment and decide how to organise care without requiring the go-ahead from managers.

Staff who form social enterprises would retain their health service pension and, at the start, would probably be able to offer services without tendering and competing for a contract.

However, if Mr Lansley’s plans for a free market in the NHS become reality, they would face the uncertainty of competing for contracts with other providers, including private firms. For that reason, critics have attacked ‘Right to Provide’ as another step towards privatisation – warning that mutuals will eventually be replaced by private health giants.

Peter Bateman, chairman of the BDA’s salaried dentists committee, said dentists were ‘thinking seriously about the advantages and disadvantages’ of joining the quiet revolution.

And he suggested the shift to mutuals opened up a route for treating ‘society’s most vulnerable patients – those who may be unable to access dental care at high street dental practices’.

However, Mr Bateman added: ‘In making any transition, dentists will be seeking to ensure that their ability to care for their patients is maintained. It will also be important that the NHS terms and conditions of primary care trust dental staff are protected during any transition.’

Nevertheless, the reaction was notably warmer than that of the British Medical Association (BMA) which warned Mr Lansley’s plans could result in chaos.

Dr Mark Porter, chairman of the BMA’s consultants committee, said: ‘It is hard to see how the NHS can operate effectively if lots of bits of it are in private hands – even if they are those of former employees.

‘New mutuals could quickly find themselves in conflict with each other and at risk of being out-competed by private healthcare giants. The consequence could be financial and operational chaos.’

Pilot schemes have been offered grants of between £50,000 and £450,000, for start-up costs, staff costs, capital expenditure and business development.

Alternatively, 25-year loans are available.

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