The findings of an independent review into how dental services in England has recommended significant changes to the way NHS dentistry is organised in England.
The independent review, led by Professor Jimmy Steele, ordered by ministers, considers the continuing problems in access to NHS dentists. These include a return to linking a significant part of a dentist's income to the number of NHS patients registered on their books. It also looks at how dentists are funded, and how to ensure high-quality NHS dental care. Another proposal is to make dentists more accountable for providing high quality, long-lasting treatments.
A new dental contract for dentists was introduced in April 2006 in an attempt to widen access for NHS patients. It aimed to reform the so-called ‘drill and fill’ culture by effectively paying dentists the same amount to see slightly fewer patients. In theory this allowed them to spend more time with their patients so they could also give them advice about oral health, rather than trying to maximise throughput to enhance their income. But it has proved highly unpopular with the profession and with the public.
Figures show 1.2 million fewer patients visited a dentist in England in the two years to June last year than in the period before the reforms were introduced. Under the contract, patients pay fixed charges for particular types of procedure and local primary care trusts have the power to commission and pay for dental services. There has been criticism that because dentists now receive a flat salary, they no longer have any financial incentive to carry out difficult work such as crowns and bridges. In the first year of the contract, the number of complex treatments including bridges and crowns that involve laboratory work was halved, and the number of root canal treatments fell by 45%. In Scotland and Northern Ireland, not covered by the changes, the number of complex treatments rose.
As well as the changes to the contractual arrangements, the report says patients need to be provided with better information. Local helplines are to be set up and NHS Direct given information about which dentists have spaces on their books for NHS patients. It also suggests the three bands of patient fees that NHS patients contribute towards the cost of their care should be widened to up to 10 bands, as the current arrangements are overly simplistic.
The recommendations will be piloted this Autumn.