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What’s in a word?

Kevin Lewis ponders the impacts of the new GDS contract and future patient access to free dentistry

There are some words that UK dentistry seems to trip over more easily than most. One of them is ‘access’, and this was the source of untold pain for the Department of Health for the best part of a decade. The ‘access problem’ was consigned to history by a combination of factors – none of which, ironically enough, had much to do with the politicians and civil servants who had juggled with this political and social hot potato for so long. Interestingly enough, the previous government was careless enough to have linked two of the more recognisable banana skins into a single strapline – the ‘Quality, Access and Choice’ agenda. Of these three, ‘Choice’, should really be the least contentious, assuming of course you can define it in a way that ensures it means precisely what you want it to mean. And, as Humpty Dumpty famously added, ‘neither more nor less.’ You get access problems not when need outstrips supply, but when local demand outstrips local supply.

And, when the scale of this mismatch reaches pandemic proportions – and there are only one or two local providers left – you get choice problems, too. And when the remaining provider(s) becomes overwhelmed by the demand, quality problems are rarely far behind. The reverse does not hold true equally well. You can have outstanding quality, but access to it may be strictly limited (on cost grounds, for example) and you can have ready access to a sea of mediocrity without any real choice at all.

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