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Special interests lot confuse PCTs
19th May 2005
On 21 April the Faculty of General Dental Practitioners (UK) and Faculty of Dental Surgery hosted an event about Dentists with Special Interests (DwSIs). It is about a year since the Department of Health published a document on implementing a scheme for such dentists, although in general medical practice they have been around since 2002. Some delegates to the April meeting were disappointed to learn that this was not a route to specialist status, but was part of future local commissioning. It would not be a registrable qualification and dentists will not be able to limit their NHS work to their chosen interest. It was essentially an add-on to their normal generalist work. As the chief dental officer explained in his January 2005 Update, they will be first and foremost generalists undertaking their special interest work within the NHS, as part of a contractual agreement with their PCT. ‘They will provide a service, which is complementary to secondary services as a whole, but will not replace those who have undergone the training required for entry to the specialist lists.’ From April 2006, PCTs will be able to commission services from dentists who can demonstrate competence in four areas: orthodontics, minor oral surgery, periodontics and endodontics. The decision as to whether to commission such services will be for the PCT to decide and it will be up to them to negotiate a price. The unanswered question is whether PCTs will want to commission services from DwSIs. The answer may well depend on money. With established specialties, such as oral surgery and orthodontics, where referral locally is usually to a hospital dental department, it will pay the PCT to commission from a DwSI in primary care, rather than more expensive secondary care. But what of referrals for periodontics and endodontics, treatments which are not normally referred, but treated within the practice? Faced with a molar endo or a complex perio case a dentist may well wish to refer it to a DwSI, indeed may feel that this is the best treatment for the patient. But there are no savings in this case for the PCT who will have to find additional resources to commission from DwSI. The scheme may well be attractive to younger dentists, who may see in it elements of some career progression and recognition of their particular talents. But it all depends on whether the PCTs pick up this initiative and run with it. This is something that may need to be pressed home by dentists and Local Dental Committees.
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