1. How did you get to your present position?
My specialist background prior to my current position was as a consultant in dental public health, to which I was originally appointed in Bedfordshire in 1992.
Immediately prior to moving to the health department and immediately prior to my appointment as deputy Chief Dental Officer in January 2009 I was a consultant in dental public health across Bedfordshire, Luton and Hertfordshire primary care trusts. During my career I have been both honorary secretary and president of the British Society of Disability and Oral Health, president of the British Association for the Study of Community Dentistry and chairman of the BASCD Consultants in Dental Public Health Group.
Some achievements that may be of interest include the development and implementation of the Bedfordshire Orthodontic Personal Dental Services pilot, working with the health department on national guidance for dentists with a special interest. During my role as president of BASCD I chaired the joint health department/BASCD working group which developed the practical toolkit Delivering better oral health.
2. When did you first become interested in dentistry as a profession?
When I was doing my A levels I went on a zoology field week, with people from a number of schools. During the week we had a careers evening and a master from one of the boys' schools suggested I might look at dentistry. I went back and spoke to my own GDP, who immediately offered me some evening and Saturday morning work in the practice so that I could see what it was like. I also had the opportunity to go on the London Hospital's 'Dental student for a day' experience, and that clinched it for me.
3. Were you encouraged by your family to become a dentist?
My family supported me when I made the decision, but they did not push me in any way.
4. Why did you choose not to go into general practice?
Having done house surgeon jobs I was interested in getting experience in special needs care and took a job in the Community Dental Service. Through that service I was given the opportunity for postgraduate training in dental public health. I wanted to do this because I became interested in how a population-based approach to oral heath could actually have a much greater impact than I as an individual could achieve in a general practice setting. However, during the period that I worked as a consultant in Dental Public Health I did work one session a week in private/NHS dental practice – a good reality check!
5. What, in your view, would be the ideal conditions/pay/incentives for dentists within the NHS?
As the recent Channel 4 Dispatches programme showed, there is no system for remunerating dentists that does not contain the potential for perverse incentives. The most distressing case in the programme was the damage done to the man from Birmingham which occurred under the old item of service system.
I think that the payment system should follow from a model of best clinical practice, based on prevention and evidence–based care. Capitation may provide a good core for remunerating dentists, but experience shows that this needs to be supported by clinical pathways which are underpinned by evidence-based guidelines, information and data. Including in this an element of payment for quality and outcomes would seem to be a very positive way forward. The current pilots are intended to test the utility of this approach.
6. Is there any way of achieving this given the current economic climate?
I support the view articulated in Prof Jimmy Steele's independent review of NHS Dental Services that we must ensure that the resource we have is invested properly in oral health, looking at a long term oral health goal. Oral health is a lifetime concept, so a contract that is based on continuing care arrangements through capitation allows long-term relationships to be established between dentists and patients. The clinical pathway approach, with its emphasis on prevention of damage caused by disease at an individual level is a high priority for investment, as every cavity or periodontal pocket represents irreversible damage, with lifetime consequences and costs. Treating disease is still inevitable where prevention fails, but emphasis on quality of restoration is important to ensure longevity and minimise further damage. Pilots will test both the clinical and financial elements of this approach.
7. Will the ideal ever be achieved?
It is extremely difficult to design a contract that is free of any perverse incentives and works in all environments, but piloting is intended to explore how we can minimise the problems and maximise the positives to develop a contract that creates a service which delivers oral health, is valued by patients and the profession and pays dentists and their teams fairly within a reasonable financial envelope.
8. There have been some complaints that the pilots have been delayed. Whose fault is this and when will the problems be resolved?
There has been an enormous amount of work to do before the pilots could go live, including:
- To finalise the required regulatory processes and underpinning documents such as the contract variation agreements and statement of financial entitlement.
- To undertake clinical training with the pilot practices, and also training with the primary care trusts
- To ensure that the underpinning software for pilot practices is robust and delivers a product that supports the practices well in the oral health assessment and care pathway approach.
All of these have now been completed.
9. Which of the three pilot schemes do you favour, or what, instinctively, do you think will work best?
The three pilot types were not intended to test discrete contractual models for implementation. They have been designed to test various elements and impacts of a contract based on capitation and quality to inform the detail of a contract for implementation.
10. Would you encourage school leavers today to go into dentistry and why?
Absolutely, I have thoroughly enjoyed my career and feel that dentistry continues to offer a wide range of career opportunities for young graduates. You only have to look at the programme for the national annual careers day conference organised for vocational trainees and feel the buzz at the event to see what a positive future there can be.
11. What are your personal ambitions?
I am really excited by the work we are doing on the dental contract pilots and my overarching ambition now is to be part of the establishment of a contract which will deliver all those thing which I have described earlier
12. How do you get away from it all?
My greatest relaxation is getting away from it all with my husband on our boat.