It all started in a very traditional way – a letter to The Times. Then head of the Royal College of GPs, Dr Clare Gerada added here powerful views; only to be rebutted by the medical director of Public Health England.
It was the row about health checks for the over-40s, which Dr Gerada called a ‘waste of time’.
The letter to The Times came from Danish researchers who said that such checks did not cut the chance of patients dying.
Public Health England stood by the scheme, saying that what they were following clinical pathways set down by NICE. There was an urgent need to tackle the growing burden of disease, it added.
Dr Gerada said that mass screening identified risk factors not diseases. ‘These will usually disappear or turn out to be irrelevant’, she claimed, ‘but we run the risk of putting people on unnecessary medication or worrying them unduly.’
Clare Gerada is a controversial figure and it is easy to dismiss this debate as yet another spat between doctors and of no concern to our profession. But, wait a minute, haven’t we spent the last 60 years at least carrying out mass screening, sometimes twice a year? Isn’t the oral health assessment at the heart of the new clinical pathways being piloted now?
It was back in 1977 that Prof Aubrey Sheiham wrote in the Lancet questioning whether the traditional six-month check-up was really necessary.
Under the old system of remuneration, half the courses of treatment consisted of an examination only or with bitewing radiographs and a quick scale and polish thrown in for good measure. It is some 10 years since the Royal College of Surgeons and NICE advocated that the interval between dental examinations should be variable between three and 24 months.
Just as Dr Gerada has claimed that the ‘over 40’ checks can lead to unnecessary medication so, in dentistry, many authorities have claimed that regular checks can lead to unnecessary treatments.
The replacement of item of service payments with capitation has been suggested as a way of dealing with this problem.
Capitation forms the basis of the Coalition’s government’s proposals for a new contract and we have been asked for feedback on the pilots. So also is the need for regular oral health assessments. So, where do you stand in this long-running debate? Will you be making your view known to those directing the pilots?