So primary care trusts are set to be disbanded along with strategic health authorities in yet another shake up in the way healthcare is delivered in England. General practices are to be given control of around £70bn of NHS expenditure, taking over the commissioning of most healthcare services. However, specialist services, such as dentistry will not fall under their remit. Thus dentistry will not have to compete with the wide range of services that our GP colleagues will be responsible for in the future, but who will replace the work of PCTs?
The Government has announced a national NHS commissioning board will be set up to fulfil this role and a new national dental contract will also be devised with a particular focus on the oral health of children. The health department’s draft structural reform plan states proposals for pilots to inform the new contract will be published in December 2010. We will have to wait until this is published to find out the status of the Steele pilots that have already been put on hold. Will the proposals include the Steele review’s work in full, in part, or in a completely revised format? It will be interesting to see which of the options the minister responsible for dentistry, Earl Howe, chooses to implement (obviously, those most compatible with the coalition Government’s priorities).
At the time of going to press, Prof Jimmy Steele was due to meet Earl Howe. Hopefully, this meeting will clarify which aspects of the work undertaken by these workstreams are to be continued and how they will fit with the Government’s proposed outcomes model.
Another issue that springs to mind is what systems the Government will set up to monitor the PDS plus contracts that have been newly commissioned. These contracts entail a complex set of key performance indicators (KPIs) being fulfilled, the number and range of which vary from PCT to PCT (and therefore arguably could be more suited to a decentralised monitoring system which caters for such differences) and they also require patient access targets to be measured on a regular basis. Will it all be done from a national board far removed from where the care is being delivered?
I also wonder what the changes will mean for UDAs. Will we finally see an end to this much disliked system; not least, the unfair variability in values? If the Government is committed to moving to a capitation scheme in the future the question still remains about interim arrangements and how these will affect UDAs.
Clearly dentistry is going to undergo yet another major upheaval. All we can do for the moment is wait and see and hope that any new measures and proposals focus on the improvement of patients’ oral health while taking into account the problems we, as a profession, have faced with the numerous new schemes that Labour implemented in recent years.