Dentistry and PCTs: Room for improvement?

After several long months, the results of our all-encompassing PCT survey are in – and with the fourth anniversary of the 2006 reforms waiting in the wings, they make uncomfortable reading.

To find out how your PCT fared, click here to view our table in which every PCT in the country has been rated by the dentists it works with.

Simply put, this is a picture of how you feel about the organisations that you work for.

10 of the best
Some Primary Care Trusts are clearly doing something right, standing head and shoulders above the rest of the country. The top 10 UK PCTs are:
1 – Salford (4.83)
2 – Bradford and Airedale (4.33)
3 – Doncaster (4.17)
4 – Calderdale (3.67)
5 – Stockport (3.67)
6 – Derbyshire County (3.54)
7 – Dudley (3.50)
8 – Devon (3.11)
9 – Tower Hamlets (2.83)
10 – Walsall (2.83)

Could do better
At the opposite end of the scale come the under
performers, PCTs that failed to bring in a single result above ‘1 = the worst, no redeeming features at all':
• Haringey
• Islington
• Manchester
• Oldham
• Richmond and Twickenham
• Sefton
• Southampton City

 At a glance – UK averages
• Ease of communication: 2.04
• Consistency in negotiations: 1.89
• Willingness to innovate: 1.74
• Professionalism: 1.97
• UDA value: 2.10
• Overall quality of relationship: 1.97
• Number of dentists who feel
their PCT has improved: 12.79%
• Overall average score: 1.95

It will probably come as little surprise to many dentists in the best areas – namely Salford, Bradford and Doncaster – that their PCTs have topped the list.

But in too many cases, the reverse is equally likely to be true; our survey has uncovered a staggering depth of resentment and ill-feeling in some areas.  Even PCTs that started off strongly were soon brought down by the negative experiences of other dentists in the same patch.

One look at the UK averages on this page shows the extent of the problem. They show a profession dissatisfied with the new contract, and with its implementation by PCTs; even after four years of ‘bedding down'.

Has there been no progress, or have the new contract's widely documented teething problems permanently soured the chance for a solid relationship between dentists and their PCTs? Perhaps this was unavoidable – after all, when you're dealing with somebody's livelihood, there is no margin for error. Any mistakes are twice as hard to come back from.

Room for improvement
Perhaps the most disheartening result to come out of the survey is the sense of how little progress has been made since 2006.

Less than 13% of the profession feels that their PCT has improved since the inception of the new contract. Likewise, ‘willingness to innovate' threw up the lowest average score across the entire country – a score that came in at 1.74, well below the median (3). Can this be a coincidence?

These statistics sit at odds with the Department of Health's claims that 2010 will be its ‘year of vindication'. They point an accusing finger at the inability of PCTs – the gatekeepers of NHS contracts – to manage their responsibilities to dental professionals.

Perhaps it's more indicative of their struggle to communicate effectively with the profession, but isn't that just as bad? The ‘them and us' mentality it can cause helps nobody.

Shaky foundations
There is an argument that innovation – or, seen another way, risk taking – has discouraged at SHA level.

While this might go some way to explaining why so many people feel their PCT has not developed since 2006, it does not excuse everything.

It's easy to use the example of Yorkshire and the Humber SHA, which oversees a number of the highest-rated PCTs in our list (Bradford, Doncaster, and Calderdale), to support the argument that SHA backing equals success.

Of course, it must play a part. But Salford – which came out top – is part of North West SHA, as are the noticeably less successful Manchester, Sefton and Oldham PCTs. The issue is not as clear-cut as it seems.

And more importantly – what good is directing blame further up the bureaucratic process, when doing so doesn't make the situation any better for dentists?

Whatever the reasons behind this lack of progress, it is hard to argue with the expectation that, after four years of practising, PCTs should be doing better. A result of 12.79% is just not good enough.

Not all about the money?
UDA values came out with the highest average score. While this was far from impressive, it at least suggests that UDA values do not always represent the biggest problem for dentists, or – to put it perhaps more accurately – that even a reasonable UDA value will not draw attention away from the PCT's other failings.

There's more to life than money – and this rings true even of life in the NHS. It's backed up by the disappointing averages across every question in our survey.

That's not to say the money isn't important, of course!

But time and time again, the UDA value comes out on top, with no sign of improvement in anything else.

Good UDA values do not help dentists feel more wanted when nobody answers their call or letter.

They don't make the threat of clawback any easier.

And on their own, they do nothing to dispel the feeling held by many that the profession is being marginalised to make way for a ‘core' dental service.

How better to dispel this worry than PCT dental commissioners building positive, long-lasting relationships with the dentists under their remit?

Yet all too often these sorts of relationships are conspicuous by their absence – and the end results are here for all to see.

Worrying pointers
Make no mistake; these results mean a dissatisfied workforce. They point to a deep resentment.

After so long, the fact that this resentment still exists is a worrying sign. It could be the wake up call the Department of Health needs – but with a general election looming, nothing is certain.

Will the Steele pilots on the horizon represent a light in the darkness? Or does the possibility of PCTs rolling out the Warbuton access contract on a wide scale render any such hope a false dawn?
Only time will tell whether the results of this survey have any chance to improve.