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Steele pilots now at full throttle

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New pilot contract a positive step says dentist

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62 practices to trial new dental contract

Dozens of NHS dental practices will shortly begin trialling new ways to deliver services under Government plans to start implementing recommendations from the Steele review.

The pilot sites will seek to improve patient access and test new ways of measuring quality from April, the Department of Health (DoH) announced.

It said primary care trusts and practices had ‘responded well' to a call for pilot sites by the Steele implementation board, and almost 30 sites around the country would soon begin trials.

One of the sites is City and Hackney, in London, where a new ‘blended contract' is being trialled under which dentists are directly rewarded for the number of patients seen, the level of treatment each patient receives and the quality of that care. Professor Jimmy Steele, who led the Independent Review of NHS Dental Services, made more than 30 recommendations to help improve oral health, increase access and ensure high quality dental care for patients in his final report published in June last year.

It followed a series of criticisms of the Government's 2006 reforms for failing to do enough to increase patient access. The reforms, which introduced local decommissioning and payment based on the unit of dental activity, prompted many dentists to leave the NHS.

The DoH said different methods of delivering Steele's recommendations would be piloted ‘thoroughly' over the next two years to ensure they met the needs of the NHS and patients. But it added that the flexibility of the current dental contract meant that if the local NHS wanted to adopt changes sooner they were able to do so.

Health minister Ann Keen said: ‘We know that access to NHS dentists is improving – more people visited a dentist in the last two years than at any period in the last decade. This is great news for patients who are now seeing the benefits of over £2 billion of investment in improving NHS dental services.

‘As well as continuing to build on this success and drive access even higher, we need to look at the quality as well of quantity of treatment being carried out by the NHS. Professor Jimmy Steele made a number of recommendations for how we can do this and it's fantastic that the local NHS is so keen to try out new ways of improving the dental care it delivers.'

Chief dental officer, Barry Cockcroft, said: ‘Prevention and quality are two of the most important principles of today's NHS and the sites piloting Professor Steele's recommendations will be at the forefront of delivering high quality services built around patients' needs.'

The Steele implementation board, which includes Professor Steele and Dr Cockcroft, is still inviting expressions of interest for sites to be part of the next wave of pilots which will start in September.

The next wave will trial a wider range of options to cover all the areas of the Steele review, including increasing access to NHS dentists, introducing patient registration, measuring quality as well as quantity of treatment, and encouraging dentists to carry out more preventive work.

The DoH said almost 1,200 more dentists were working in the NHS that two years ago, while the number of patients seeing an NHS dentist was now at its highest level in the past decade.

Dr John Milne, chairman of the BDA's General Dental Practice Committee, said: ‘The BDA has called for reform to deliver an NHS dental system that works better for patients and dentists alike, and we support the process of piloting the conclusions of Professor Steele's review.

‘The two keys to the success of these pilots are meaningful engagement with the profession and proper evaluation of their results. Engagement so far has been good and must continue. These pilots must now be given the time they need to properly assess the proposed changes and allow reflection on the results.'

Peter Vicary-Smith, chief executive of consumer group Which?, said: ‘We are pleased to see the Steele recommendations being put into practice. Full piloting with patients is essential to ensure that any new system of NHS dental services is fit for purpose.'

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'directly rewarded for the number of patients seen, the level of treatment each patient receives and the quality of that care'
Sounds a tiny bit like item of service with quality testing - probably via DRO inspection.
My, how absolutely brilliant, innovative, imaginative and novel.
Ann Keen likes it, so it must be great (Google 'Alan and Ann Keen expenses').
Too late for pilots. Time to bail out!

Posted by drstephenmorris 15/3/10 at 23:54

We will see which parts of the Steele review the DOH is keen to pilot . Access is what the DOH is obsessed with. Just got back from an LDC meeting where we found out that tsome PCT's are asking the providers (who sign the new warburton or the so called access contracts) to indemnify the PCT against any legal claims from the patients if these patients can not access NHS dental Services. Madness! Obviously any provider crazy enough to sign a contract like this will not have any cover from Dental Protection or the DDU. I am wondering what the DOH is cooking up for us while piloting the Steele review
This is how the DOH and PCT's are treating the Dentists. Shameful!

Posted by Frasse 16/3/10 at 00:59

Frasse, anyone who signs a contract with clauses such as you describe needs 'access' themselves - but only to psychiatric care services. So, let me summarise: NHS practice signs such a ludicrous con-trick. Dentists get ill/pregnant/whatever. PCT can't get Mrs Grot-Gob seen with the next 2 hours, at her convenience. She has to spend some of her fag/booze/benefit money on (eg) me doling her some antibiotics privately. She then gets some no-win-no-fee ambulance chasers to sue the PCT, who can then deduct my fees from the NHS practice contract to refund Mrs Grot-Gob? Actually, if I was a naughty boy, I might advertise a drop-in private clinic and tell patients how to get the fees back via the PCT! :-)
Seriously, though, such contractual clauses would probably be ruled unreasonable by a court. So signing-up might invalidate the whole contract. But you would need 'balls of steel' to be the one to test-out this ........

Posted by drstephenmorris 16/3/10 at 07:47

Unforturnately there will be someone who will sell us out and take up this contract. Government will then feel enough have support for it and roll it out on all of us....

Posted by shazzie 16/3/10 at 11:06

Well here is the problem; the fact that the clowns have already said that the current contracts have an element of flexibility in them to be modified without change of legislation should start to ring the alarm bells****. contract likely to be modified to incorporate all the kpi's quality, access - pt lists etc.
what i still find bemusing is the steele report had v little input from GDP's i.e. the ones's on the front line. it's ok for dentists to talk the talk and say how primary care should be run when in fact they have no experience in it whatsoever.
let the games begin

Posted by steve 16/3/10 at 11:41

steve - quite. Why doesn't the Government ask one of us GDP's how dental schools and secondary dental care should be funded and organised? Just as valid as asking the salaried academics how our small businesses should be run, IMHO! The answers might not be what the ivory tower dwellers would want. When the 'solids hit the aircon' wrt the public spending deficit before too long, I suspect some of said academics might be unexpectedly trying to learn how to work in practice ....... some might succeed. But not many. Some have already stuck a toe in the water and promptly retreated.

Posted by drstephenmorris 16/3/10 at 15:14

Brilliantly put, drstephenmorris, but why don't you all just solve all the problem PCT issues by going private? I did in 1999 and have never looked back. You are free to provide the highest standard of care for your patients, keep up with innovations (and be able to afford to implement them in practice) and charge a reasonable level of remuneration to suitably reward your skill and dedication instead of being continually insulted and treated like a kind of social slave by a purse string holding third party. If we all ditched the NHS this would (in response to the ensuing public outcry) force the government to do something fair and realistic to secure your services rather that continuously fobbing you off and exploiting your skill and professionalism in the way they effectively now have a licence to do. If the public feel that they are entitlled to cheap / free dentistry then this is an issue that should not be our responsibility to address: it is an issue for the department of health to deal with. Paying professional people paltry, insulting fees in order to obtain their vital services, which only they can provide, in return for as little as possible should not be on the menu of solutions, and absolutely should not be tolerated by our profession either collectively or as individuals. Just do it! We did, and life is so much easier and more rewarding in every way. I really look forward to every day I spend in the surgery as does my partner who works with me and the relationships we build with our patients, who really appreciate what we can do for them, are like nothing we could have cultivated in the bad old days when we were NHS slaves.

Posted by biker2260 18/3/10 at 09:49

Thanks, Biker. We are 95% private. We are mostly Denplan Essentials, a few private IOS, and a vestigial kids-only contract which serves the main purpose of dynamising our NHS pension pots.....and which probably isn't worth the hassle, frankly, any more. I fully agree with all you say. As far as I am concerned, anyone who wants 'access' to the sort of blood/forceps/acrylic dentistry which is what some (not all, note) NHS practices are offering is very welcome to it. I'm happy to say a large majority of our patients were brighter than to accept such a regression in their oral care, and stayed with us. Some are still drifting back 4+ years later, usually with tales of woe, neglected perio, etc etc.

Posted by drstephenmorris 22/3/10 at 00:13

Has anyone read the snail-mail version?! I.e 'Steele pilots torpedoed'. Superb! Couldn't make it up. Full throttle to torpedoed in about 10 days. Now, I'm not one to say 'told you so' but.........

Posted by drstephenmorris 2/4/10 at 00:42

P.S
Don't pilots get shot down? I thought mariners would be more likely to get torpedoed.
Get ready for your new, new, new, new contricks, courtesy of the Conservative party. Enjoy.

--This post was last edited on 2/4/10 at 00:50--

Posted by drstephenmorris 2/4/10 at 00:45