The dental profession is about to enter a whole new era – yet again! Those of us involved in NHS dentistry are preparing to face significant changes in how we are remunerated and monitored. The new series of NHS pilots allocated by PCTs – based on Prof Jimmy Steele’s report – are due to start. There will be the inevitable difficulties, improbabilities and inaccuracies revealed – that’s why you have pilots? Dentists are business people as well as dental health care professionals and they will surely make them work.
The immediate future looks very uncertain with PCT s (you either love or hate them) being disbanded and our ‘colleagues in arms’ the GPs allegedly holding the purse strings. The General Dental Council and the Care Quality Commission (both universally mistrusted) are there to advise, monitor and police this potential tower of paperwork. They will respond to patient complaints and PCT issues to ensure that the treatment is being provided honestly, ethically and is in the best interests of the patient.
So how will this be achieved? How will these regulators ensure that NHS dentistry is being delivered according to GDC standards? Patient perception of treatment and costs incurred can be confused, exaggerated and often misinterpreted.
There used to be a system of checking and policing called the Dental Reference Service (DRS) that employed 28 dental reference officers. These highly trained dentists inspected patients’ mouths and record cards to ensure that what had been claimed for had indeed been completed. As with many systems it had its problems – perfect it wasn’t – but it was there. So with them gone how in the future will the NHS be able to ensure that what has been paid out is justified? Will it be sufficient to produce treatment plans on impressive notepaper giving reasoned options (it certainly seems worth buying the software that provides this at the click of a mouse and keeps the box-tickers happy!) and patient information leaflets with exotic options and pages of simplified text as evidence of a thorough evaluation of the patient. Will they be able to diagnose supervised neglect from the X-rays?
If I were running a business with a few billion pounds turnover I would be anxious that as well as getting value for money, patients were getting the treatment they needed. In the past the DROs targeted the minority of dentists who ‘played the system’. Thankfully most dentists just get on with working with patients and accepting whatever is thrown at them by the health department. It would seem that by disbanding the DRS they have done both themselves and possibly the patients a great disservice and by making the DROs redundant have lost an important skills source.
It will be interesting to follow the progress of NHS dentistry over the next few years. There will, no doubt, be another review and perhaps the realisation that the health department is creating more problems than they think they are solving now. One could even ponder on what they might call replacement DROs?