Is there a glimmer at the end of the NHS tunnel?
Nigel Jones discusses Sara Hurley’s latest briefing with Simon Thackeray and Tony Kilcoyne.
When Sara Hurley, chief dental officer (CDO) for England, held a briefing to share her team’s vision for NHS dentistry with key stakeholders, I was delighted to be among their number.
On the day’s agenda were a myriad of critical issues including, but not limited to, how the CDO and her team are placed to make a difference moving forward, how to engage hard-to-reach patients, and the possibility of prescription exemptions for dental hygienists and therapists.
You can hear everything that was said at blog.practiceplan.co.uk/office-of-the-cdo-explained.
To build on this new level of awareness, I met with Simon Thackeray and Tony Kilcoyne, for a very interesting discussion, putting the world of dentistry to rights. Simon is the principal dentist of a private practice, and is known for voicing his opinions about the bureaucracy laid at dentists’ feet in modern practice. Tony, meanwhile, works in a specialist referral practice in Yorkshire, is a member of the BDA’s Principal Executive Committee, as well as a current foundation training programme director (VT adviser) for Leeds University, and a well-known national media campaigner.
A new dental dialogue
Nigel: During the briefing, the CDO and her team shared with those of us in the audience the complex hierarchical structure within which they have to work. So complex, in fact, that there is no way to explain it here. Simon, what are your thoughts about this chain of command and whether it can bring about positive change in dentistry in England?
Simon: I’m not convinced there will be any positive change in NHS dentistry. The complex hierarchy means that the CDO’s position is no longer as senior as it once was. To me, this indicates the relatively low importance of dentistry within Government, especially when compared to medicine.
Nigel: Sara also spoke about the political and funding landscape of dentistry as the ‘elephant in the room’, in relation to coping with the increasing population, the changes in disease experiences, public attitude and awareness, and treatment uptake. Why do you think she categorised it as such and do you think it was then adequately addressed?
Simon: I’m not sure why it has taken the CDO so long to realise there is an elephant in the room with regards to funding. We are in an era of austerity, and any innovative ways of working are going to take a financial commitment that is just not going to be forthcoming, especially if it reduces access.
As for public awareness of dentistry, it is not helped by the lack of responsibility that some patients show for their dental conditions. Whilst disease experience will change through time, without a concerted and highly consistent educational push from many different angles simultaneously, coupled with an actual requirement for more people to take full responsibility for their health (rather than expecting the state to provide all, or blame and sue the dentist), then there is always going to be a problem.
The other elephant in the room is the system, yet there is no sign of a radical redesign of the NHS contract to benefit anyone other than the accountants in Whitehall, in my opinion. Perhaps if our friends at the GDC would acknowledge that one of the problems with dentistry is the system within which many dentists work, then there might be some light at the end of the tunnel.
Nigel: Since you have mentioned the GDC, it might be a good moment to talk about what Jonathan Green, the GDC’s executive director of fitness to practise, said at the briefing about trying to balance the provision of high standards in patient care with the need for an efficient delivery model: ‘When I sit in and observe fitness to practise hearings, very often part of a registrant’s defence is that their record-keeping struggled because they were up against it in terms of time. We and our panels are sympathetic to that, but obviously it’s something that needs to be addressed as part of the regulatory picture.’
Tony, if I can turn to you here, what did you think about that?
Tony: It is good that the GDC is considering looking at various extrinsic factors, and particularly the high burden of notes and admin that is peculiar to dentistry. Indeed, so onerous are these requirements that they may occupy 50% of the time we should be devoting to direct patient care.
Obviously, this leads to compromise somewhere; should a clinician spend a burdensome amount of time creating detailed notes for defence purposes in the event of a complaint in our increasingly litigious society, or should we put patient care first, devoting the time needed for treatment but accepting briefer note-taking and recording? Of course, the answer is to reduce the burden of current, ultra-defensive dentistry, to benefit all patients.
Nigel: Taking a bit of a tangent from what we have been talking about so far, the work of the CDO’s team with Local Dental Networks (LDNs) was also the subject of discussion. What do you think about that element of their work, Simon?
Simon: Many people seem to think that LDNs offer the way forward in relation to the commissioning of future dental need. I haven’t had much experience of them but, that said, I can’t see how they could work effectively, given the lack of funding. Unless there is a complete rethink of the NHS contract – and for me that would mean reducing it to a core service – there isn’t the money. In addition, if there is a return to central commissioning, then LDNs will be rendered irrelevant, or at best allowed to tinker with slight changes only, which are not likely to have a huge effect on the dental health of local residents.
Nigel: There was also some interesting talk about prescription exemptions for dental hygienists and therapists, and that a public consultation would be part of the processes involved in trying to bring that to fruition. What are your thoughts about that?
Tony: This would be funny if it wasn’t typical Department of Health (DH). Hygienists and therapists could prescribe and give competent local anaesthesia before 2006. However, the DH lawyers created some major flaws when changing the laws and names from PCDs (professionals complementary to dentistry) to DCPs (dental care professionals). This process lost our therapists and hygienists their prescribing rights. Thus, this is nothing new and is an attempt to fix a 10-year-old problem of their own making. Of course, mistakes don’t get so easily admitted, so it’s repackaged as something ‘new’ or innovative, when that’s simply not the case.
Nigel: Thank you both very much for sharing your thoughts on the briefing. Your understanding of the issues discussed and the challenges ahead offer unique insight, and I am hopeful that all the parties, from the CDO’s office to the DH and the GDC, and everyone in-between, can work together, for a brighter future for all.
Practice Plan is a specialist provider of practice-branded patient membership plans. To find out more visit nhs.practiceplan.co.uk.
About the CDO’s briefing
The Office of the Chief Dental Officer England brought together a panel of leading members within NHS England, Public Health England, Care Quality Commission, British Dental Association, Health Education England, and the Department of Health on 12 June 2017, to answer the most asked questions on NHS dentistry.
Nigel Jones is sales and marketing director at Practice Plan, specialist provider of practice-branded dental plans. He first began helping dentists convert from the NHS to private care in 1990, and has supported the development of successful private practices throughout the majority of his 27-year career.
Simon Thackeray has been a GDP since qualifying in 1991, initially in the NHS, and since 2005 in private practice in Nottinghamshire. Simon sits on the GDPC committee of the BDA and is also a past BDA Branch President for South Yorkshire.
Tony Kilcoyne works mainly in his own specialist referral practice and teaching centre. His vast knowledge and experiences are now utilised by mainsteam media with programmes for ITV, C4 and the BBC and he is currently best known as the ‘resident dentist’ for the popular BBC Radio 2 Jeremy Vine Show.