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Issues with New Dental Contract

I sent the following letter to Ann Keen at the Department of Health on 15 January 2009 in response to a report from South Birmingham PCT about dental care in the region. The findings of the report tied into concerns with the dental system that I had previously raised on behalf of various constituents.

Dear Ann,

I am writing to you to highlight a number of issues raised in a recent South Birmingham PCT ‘Report to the Board’ entitled ‘Oral Health Improvement and Dental Commissioning Strategy’, which relates directly to correspondences I exchanged with you last year about dentistry.

I have enclosed extracts from this report for your information, which focus on two particular areas of concern: perverse incentives created by the structure of the new dental contract; and a lack of clarity about what services are and are not available on the NHS.

I passed on concerns from constituents about both of these issues over the course of last year and thought it would be worthwhile to point out that this report shows that these were not unique or isolated incidents and that action needs to be taken to address both. 

From the first extract, entitled ‘effectiveness of the new contractual agreement’, it is clear that the nature of the UDA system means that dentists may well be incentivised to focus on larger more complex treatments.  Of course, it is possible that this may lead to some unscrupulous dentists pushing more complex treatments when simpler ones would be more appropriate to increase income.  However, the more likely possibility, highlighted in the report, is that simpler treatments, that can prevent the need for more complex treatments later, will be given a lower priority due to their low UDA rating.

In the second extract, entitled ‘contribution of private dentistry to dental services’, a number of issues are raised, all of which relate to the general problem of an uncertainty amongst patients about which procedures are available on the NHS and which must be undertaken privately.   I have previously contacted you about root canal treatments, mentioned specifically in the report, which have been carried out privately when an NHS alternative was available but not made apparent to the patient in question.  As the report suggests, such situations can occur when inadequate or insufficient information is made available; when there is a lack of clarity about whether a service should be available, as with certain cosmetic procedures; or where a lack of skills mean that a service which a patient should be able to receive from the NHS must be undertaken privately.

Both of these issues are clearly worrying and should be sufficient, along with other concerns and reservations that have been expressed, to prompt the consideration of a reassessment of the new dental contract and other aspects of the sector. 

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