Issues with New
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.
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
back to to health