Michael Watson reports on the latest publication from NHS England about diabetes and oral health.
NHS England has recently published its Commissioning standard: dental care for people with diabetes, something I, as a type 2 diabetic, have been waiting for since I don’t know when.
The document, Commissioning standard: dental care for people with diabetes, has been developed in recognition of the link between gum disease and diabetes.
So three cheers to NHS England?
Well no, perhaps two.
On the positive side, it is good that those responsible for commissioning recognise that high blood sugar levels and poor periodontal health go together.
Likewise improving one will improve the other and improving both is a win/win.
It will be another plus if GPs start referring diabetic patients to a dental practice for a periodontal assessment and any necessary treatment.
Likewise, if dental professionals find a patient with poor periodontal health, they carry out a simple blood sugar test and refer, if necessary, to their GP.
We now come to the ‘buts’, plus the impenetrable prose that exists in all NHS documents, words such as ‘underpinned’ and phrases such as ‘awareness raising’, which are never found in ordinary speech.
First let us look at the idea from a patient’s point of view, someone perhaps whose idea of regular attendance at a dentist is once every five years.
On being advised to see a dentist for a periodontal assessment, the reluctant patients’ first question may well be ‘will you find me one? Because I can’t.’
Going to a dental practice to have your pocket depths measured is not a fun outing, unless being prodded in the mouth with a perio probe is your idea of enjoyment.
Then, when you leave, you will be asked for £22.70 for the privilege.
And on top of that is any treatment I need – probably band 2 periodontal every three months or so at £62.10 a time – and politicians talk of an NHS free at the point of delivery.
Turning to the dentists, NHS England are asking them to take on additional patients who may easily cost them money to treat.
The financial cost of diabetes
As a diabetic, I get all prescriptions free, all eye tests, including retinal screening free and also have my feet checked by a podiatrist again free, but to have my periodontal tissues examined by a dentist, hygienist or therapist will cost me.
My diabetic care means more work for my GP, pharmacist, optician and podiatrist, but they receive more funding to do it.
Commissioners will find that no amount of working ‘with their local dental network and associated managed clinical networks to redesign services’ will overcome this basic funding obstacle.
The NHS document though says: ‘The recommended changes outlined in this document relate to new procurements only and will involve redirection of an existing resource’.
Cutting out the jargon this means no universal roll-out, no new money.
Perhaps two cheers was being a little generous of me.
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