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Orthodontists fight ‘rations’
1st Sep 2006
The new contract means the ‘rationing’ of NHS orthodontic care
Orthodontists nationwide are having to ‘ration’ treatment on patients as restrictions enforced by the new contract continue to cause problems. This follows the news reported by Dentistry magazine in April that orthodontic care was already under threat because of the contract changes. The situation has since worsened, with the British Orthodontic Society (BOS) predicting that waiting lists for specialist referrals will lengthen. A recent BOS investigation has also said that the revised NHS contracts could put some new practices out of business. Chris Kettler, BOS executive secretary, said: ‘When patients are ready for treatment they are being assessed according to IOTN (the Index of Orthodontic Treatment Need), and unless they meet the criteria of 3.6 or above, they are not eligible.’ Meanwhile, concerned patients are flooding the BOS with calls. Dr Kettler said: ‘We are advising patients that the rules have changed, and those who did not meet the criteria and still wanted treatment would have to consider the private option.’ But despite this, he is still encouraging dentists to continue to refer patients for an orthodontic assessment, as many orthodontists prefer to do initial screenings on patients from the age of eight. He said: ‘Patients who had been on review think they remain eligible for treatment, but this is not necessarily the case. However, patients who have been accepted for treatment and are on a treatment waiting list are eligible, and every patient is entitled to an orthodontic assessment by a specialist.’ The new orthodontic contracts have been based on workloads during a reference period in 2005. With orthodontic work taking around two years, payments during this reference period covered work starting as far back as 2003. Many practices have since expanded their service at the request of their local health trust, but orthodontists say that this increase in work was not taken into account. The result is that practices all over the country have had to cut their case load. In Shropshire, orthodontist Colin Purkis has had to reduce the number of children he sees by half after his practice was encouraged to expand because Shropshire is recognised as an area of high need. ‘We’re frustrated sitting here wanting to do work, and able to do the work,’ he said. ‘We can increase our work level back to 400 children a year, but we’re stuck at 200 a year and we can’t do any more.’ The Department of Health (DoH) acknowledges that some orthodontic practices have expanded since the reference period for working out contract levels. It adds that it remains up to local Primary Care Trusts (PCTs) to decide whether to fund all these cases. But Purkis is angry with the response. He said that the local PCT cannot afford it when it has so many conflicting priorities for its limited funding. He believes the government should change the contract values, not shift responsibility to a local level. Like many orthodontists, Mr Purkis only signed his contract in dispute and has been unable to increase his funding. His PCT is now waiting to hear back from the litigation authority. ‘If this doesn’t increase the value of my contract, I am willing to take the DoH to court,’ he warned. Mr Purkis said that there was a statutory document stating that an increase in workload should be taken into account. Dr Kettler said: ‘The NHS Litigation Authority (NHSLA) is simply making sure that PCTs are following the Department of Health guidelines. ‘Whether the guidance is appropriate or the rules are fair does not concern the NHSLA – all they are interested in is checking that the PCTs are complying with the contract guidance.’ He added that BOS representatives have had two meetings with the DoH, with another scheduled this month to address problems such as the inadequate funding. For example, practices with a low contract value are unable to fund the complete treatment and retention for those patients who were in treatment on 1 April earlier this year. Dr Kettler concluded: ‘The BOS will continue to negotiate with the DoH to support these practices. We are also doing what we can to encourage all our members to build their private practices.’
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