I issued the following press release on 23.02.2006
ACCESS TO NHS DENTISTRY IN BIRMINGHAM
In advance of a meeting being organised by Birmingham NHS concern, Lynne Jones, MP for Birmingham Selly Oak, has issued the following statement (see notes to editors) expressing her confidence that there will be adequate NHS dentistry in Birmingham and expressing concern about the misleading nature of the campaign organised by the local dental committee which is causing patients unnecessary alarm.
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Notes to Editors:
NHS DENTISTRY IN BIRMINGHAM
Lynne Jones MP, 23 February 2006
Birmingham’s Local Dental Committee (LDC) have organised a publicity campaign suggesting that there may be no NHS dentistry after 1 April when the new dental contract is to be introduced. After looking into these concerns, including meeting with LDC representatives, the Minister with responsibility for dentistry (Rosie Winterton) and the Chief Medical Officer (himself a former NHS dentist) I have come to the conclusion that the campaign is misleading and is causing unjustifiable alarm to many patients.
Within Selly Oak constituency, two practices have written to their patients informing them that they are leaving the NHS and offering alternative dental plans involving monthly payments.
Patients should be aware that they have not officially informed the NHS that they are withdrawing from NHS dentistry and it would appear that they are therefore keeping their options open, perhaps depending on the numbers of patients signing up to their monthly payment plans. There are 68 dental practices in South Birmingham and the vast majority have stated their intention to sign up to the new contract.
My own dentist is one of those who have written to patients about withdrawing from NHS provision and has told me and my family that “we have evaluated these changes (in the new contract) carefully and have concluded the best way we can provide care to our own patients is outside the NHS”. The other has stated that the contract “does not reflect the aims and ideals of this practice”.
Neither gives any reasons for their views.
In contrast, the Consumers’ Association (Which?) an independent, not for profit organisation says:
“Which? welcomes the Government’s package of reforms intended to modernise dental provision, including the new NHS dental contract, system of patient charges and PCT (Primary Care Trust) commissioning of services.”
“We wholeheartedly agree that reform of the current system of patient charges for NHS dental treatment is long overdue. When Which? made the Supercomplaint on private dentistry to the Office of Fair trading in 2001, we highlighted the way the complexity of NHS charges contributed to patients’ confusion about whether treatment was NHS or private. For the public, trying to find out what NHS treatment might cost or what is covered by the NHS is like trying to find a needle in a haystack.”
Which? do make criticisms of Government policy, with which I am in agreement. As you will appreciate I am not a slave to Government policy and will criticise when criticism is due!
However the Which? criticisms are generally somewhat different to those made by some of the dentists who are causing such anxiety! The exception seems to be the need to more adequately define what constitutes an emergency – for which a lower band of remuneration is paid. Dentists have claimed that people who don’t look after their oral health and thus require emergency treatment will be subsidised by those that do. Which? have called for guidance over what constitutes an emergency. Our local PCT (South Birmingham), to whom responsibility for commissioning dental services will be devolved from 1 April, have decided this means treatment to alleviate pain, which I think is reasonable. I will explore this issue further.
In South Birmingham, we have good NHS dental services and I will work to ensure that this remains the case. I have told my own dentist that if he does not change his mind over leaving the NHS, I will be changing to another practice. I am confident that there will be sufficient NHS dentistry available locally for constituents who take the same stance, albeit, like me, perhaps reluctantly.
According to our PCT, they have been given sufficient funding to pay for all the NHS treatment that took place last year plus funding to allow the payment of a further 4 full time dentists. Thanks to the additional throughput in our dental schools since Labour came to power (and we are fortunate to have a dental school associated with Birmingham University), there are enough qualified dentists willing to work for the NHS to replace the few who will join the large number of dentists who are already in private practice.
After talking to some of the dentists who are also constituents, I do accept that there are problems with some practices who want to offer contracts to their vocational trainees because the contracts on offer are based on last year’s work, for the most part of which their trainees were not fully qualified (and therefore did less work). If dentists currently contracted to provide NHS dentistry pull out, the money will be available to expand other practices that stay with the NHS but I must emphasise that the problem here is one of dentists wishing to expand, not contract, their services!
I also have to acknowledge that some NHS dentists have been offered contracts based on an atypical year. This arises through personal situations such as ill health or maternity leave. I am informed that there is scope to renegotiate these contracts with the PCT. This is another issue where I feel dentists have some justifiable concerns. But the bottom line is that there will be funding for more, not less, NHS dentistry in 2006 compared with 2005, building on previous years’ increases.
In the past, when dentists have retired or given up or reduced NHS service, the money saved has returned to the Department of Health rather than the locality deprived of service and then has been redistributed to any practitioner who cared to set up business. Under the new arrangements, this will no longer be the case and it will be for the PCT as commissioner of service for local needs who will decide where new NHS provision should go.
South Birmingham PCT will be undertaking work to identify areas that have low levels of registration and poor oral health in order to target areas for improved levels of dental access and treatment. They say the new contract arrangements will bring commissioning to the local level, will make charges simpler and will re-engineer practice so dentists spend less time on healthy patients.
Furthermore, the new contract is in response to dentists’ own aspiration to get away from the “old drill and fill” contract, whereby dentists were paid a fee per item of work they did. Interestingly, we have learned from pilot schemes that, if paid a fixed amount, dentists did 20-30% less work (and sometimes as much as 50% less work) than under the existing “piece rate” system in which the more work a dentist undertakes on your teeth, the more they get paid. The Chief Dental Officer reckoned that around 20% less work is justified if time is spent on promoting a more preventative approach. Under the reforms, dentists will have a guaranteed annual NHS income – an average of £80,000 per year for a committed NHS dentist (plus expenses of a similar amount) - for which they will be required to provide an agreed level of service – the compromise position from the pilots mentioned above. This allows for the removal of incentives to do either unnecessary work or a high volume of poor work on the NHS.
Part of the Government’s rationale for changing the contract is also in response to recommendations by the independent body, the National Institute for Clinical Excellence, which advises the Government on what treatments should be available on the NHS. One of the key provisions in the NICE guidance is the recommendation that the interval between check-ups should be determined specifically for each patient on the basis of an assessment of disease levels and risk of or from dental disease, rather than set at an automatic six months for everyone. This seems sensible to me as if you are young, or elderly, then six month or even more frequent check-ups are needed, but for middle-aged people (excepting pregnant women) less frequent check-ups should be adequate, given the lower level of risk of dental disease. It does not make sense for patients and the NHS to pay dentists for six-month check ups and associated scale and polish for everyone if these are not clinically necessary. By the way, I now know I have been paying for the latter privately without realising it – see Which? comments above. Despite this, the dental plans on offer from dentists trying to persuade patients to go in for a monthly private plan do just that. Patients are being asked to pay about £10 a month (£120 a year) for two check-ups, advice and dental hygiene treatments that they may not need. The charge does not cover other treatments but does provide for a 20% discount on the (unspecified) charges for these.
The new NHS patient charge arrangements have been developed by the Department of Health in conjunction with patient and consumer groups like Which?. The current confusing system of around 400 charges will be abolished and replaced by three bands of charges for whole courses of treatment. A report to the Board of the South Birmingham Primary Care Trust explains that these bands will be £15.50 (Band 1) for a preventive package including check-up, X-rays, scale and polish and oral health advice as necessary (compared to the current charge of £15.04 for a check-up and scale and polish only); £41 (Band 2) for a whole course of treatment (beginning with a check-up) that includes simple treatments like fillings) and £189 (Band 3) for a course of treatment that includes more complicated treatments (eg bridges, dentures). These price brackets may not be perfect and may need tweaking, particularly for patients who need to replace either dentures or an orthodontic device that are lost or damaged beyond repair, but it has to be of benefit for patients that the maximum NHS charge is reduced from £384 to £183! Dentists will be able to offer privare treatment to NHS patients but it will be clear what is private and what is NHS.
There are other areas in which I am not convinced that the dentists’ complaints are justified. For example the Birmingham LDC has complained that:
“Practices will be unable to refuse a patient unless the patient is violent, this was not the case in our previous contract, when Dentists were free to choose if they accepted a patient or not.”
It seems to me that this provision is designed to prevent discrimination and I do not see why an NHS dentist should be permitted to discriminate.
Overall, I think the new contract could be a real improvement on the current situation but there will always be problems in introducing new methods of working. When Birmingham Labour MPs met the Minister, she made it clear that the Government wants to work with the dental profession to make sure the reforms deliver their intended benefits. To this end, a national implementation group is to be set up and the British Dental Association have been invited to send a representative. We pressed the Minister to include a representative committed to NHS dentistry from Birmingham and she promised to look favourably at this suggestion.
LYNNE JONES MP
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