Articles, Dentistry

Pilot extensions

The Department of Health has announced that the 90 dental pilots will be extended until March 2015. It has also published a report from Professor Jimmy Steele from the evidence and learning group. Like most Government reports it is not an easy read. The detail in the report is impressive; it does not, however, answer two questions: how do its findings relate to the realities of general dental practice and how does the extension of the pilots affect the introduction of a new contract?

To begin with the positives, evidence from the pilots is that patients and dentists continue to like the concept of a pathway. Risks are being managed and routine treatment is being provided. Oral health is, on the whole, benefiting, although there are variations across the pilots.

On the negative side, some practices have experienced a reduction in the number of patients seen; others, however, have been able to adapt to the new system. On the whole, the latter tend to be the larger practices, which can use skill mix in an innovative way. There has also been little progress towards providing advanced care through a pathway approach.

Considering that RAG scores (the red, amber and green ratings for risk of further disease) are central to the concept of a pathway, it is surprising to read that there is doubt about what their purpose is. Although the whole idea of the new system is to encourage a more preventative approach, the report appears to cast doubt on this central concept.

It says: 'If the effort to prevent disease is significantly greater than the effort to treat it, no matter what the lifetime benefits, in the short term it will not appear to make sense.' Put simply this appears to mean that it may well be cheaper to fill the tooth rather than try and persuade patients to alter their lifestyle to prevent the decay.

These pilots are about far more than changes to the dental contract. As the minister, Earl Howe, said at the start of the process, this is about prevention not intervention. If implemented, there will be practices staffed not by one or two dentists but larger set-ups, involving dental care professionals and dentists, some of whom will have specialist skills. This requires a fundamental change in the structure and philosophy of NHS dental practices. It will not be achieved merely by tinkering with the dental contract.

The pilots have been extended until 2015, just before the general election will take place. Although the direction of travel seems apparent, the Department of Health has given little indication about how the end could be achieved through changing the contract. We are told that this will be 'contract reform' rather than a new contract. Until the Government gives the profession some indication of their intentions, I for one will remain sceptical.

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