Draft documents are fun, especially as they are increasingly disclosed under freedom of information legislation. They allow authors to make the most outrageous suggestions, which can then be denied by the great and the good on the grounds that ‘it is only a draft document’. So let us dream up a draft document on car servicing
It might start something like this: ‘Historically, car owners have been encouraged to visit their garage every twelve months. Those with the highest level of motivation and in general better maintained cars have come to expect this from contact with garage services as they attend for reassurance and often have their car washed and valeted, rather than attending after an interval that is based on their car maintenance needs’.
OK, that draft does not exist, but replace ‘car owners’ with ‘dental patients’, ‘every twelve months’ with every six months’ and ‘garage services’ with ‘dental services’ and we have not a draft document but an actual one put out by the health department. Its dental access team is against everyone having a six month recall, labelling it as ‘inappropriate’ and it wants to discourage this well established and liked practice.
What they mean is that by recalling patients at six month or more frequent intervals dentists are working to capacity on their ‘regular’ patients. Thus they cannot see new patients and the Government cannot hit its access targets. The access team is not alone. The Conservatives have condemned a system whereby ‘patients are recalled for routine check-ups just weeks after treatment and without clinical need’. Get rid of that, they say, and they can offer care to one million extra patients.
Ever since Prof Sheiham questioned the need for six-monthly check-ups over 30 years ago, thousands if not millions of words have been written on the subject. But say what you like about the professor, and many people do, he was looking at it from a clinical point of view. His arguments and the NICE guidance that followed looked at what was best for patients.
What the dental access team and the Conservative party are looking at is what is best for them to reach their access targets. The six-month recall is ‘inappropriate’ for primary care trusts trying to reach their targets, not necessarily inappropriate for patient care. Isn’t it time someone spoke up for patients to be seen when they want, not when it is best for the PCT? Dentists should be able to provide this without having to look over their shoulders at what their PCT wants.
The analogy with car servicing is apposite. We take our cars in for servicing whenever the manual or the garage tells us to do this. We have our eyes tested when we are sent a reminder. We are ruled in many ways by the calendar. Once a year our car and house insurances come up for renewal, our TV licences last a year, once a year we have to put in a tax return.
So once or twice a year our patients want their teeth checked. But now they are being told that they should attend ‘after an interval that is based on their oral health needs’. If the health department was being honest they would say patients should attend ‘after an interval that is based on their PCT’s access target needs’.
Looking at it from the charge-paying patients’ point of view, they are paying £16.50 for their check-up. For many of them this may be three quarters of the amount the dentist is paid, for some it will be more than the dentist receives. So they should have a right to decide on their own recall interval on the ‘he who pays the piper calls the tune’ principle.
In the old days, and now in Scotland, there are time bars. So you cannot have a check-up more often than once every six months, no argument. It should be possible for a PCT to do the same in England. Only credit UDAs for Band 1 course of treatment if it is at least a year since the previous one.
Problem solved – or is it? The number of UDAs delivered will decline, so the PCTs will miss out on their UDA targets. They also need to have a high number of UDAs if they are going to maintain their level of patients’ charges. Dentists will tell their patients that if they want to come at six month intervals they will have to be private patients, an offer many will accept. So PCTs will also miss out on their access targets as the number seen under the NHS will also decline.
PCTs have a dilemma: they can have a high level of UDAs and the corresponding income from patients’ charges or they can have ‘appropriate’ recall intervals; they cannot have both. They and their masters at the department have passed this dilemma on to their dentists. We have been told that we must maintain our level of UDAs we provide and see patients at ‘appropriate’ recall intervals. Problem solved for them but not, unfortunately, for us.