Although I am writing this in steaming heat which is more redolent of Borneo than Bournemouth, I have little doubt that by the time you read it we will be back to normal summer service: light drizzle with gales forecast.
I’m not keen on excessive heat. Indeed, following the (then) two hottest summers on record (1975 and 1976) I took the extreme step of installing air conditioning in my practice. The predictable result was that we didn’t have a decent summer in 10 years...
Things were hotting up recently at the Westminster Health Forum too. A variety of speakers from both within and without the profession gave their views on the future of dentistry, and the same – well, largely the same – group of observers as in previous years was there to glean what they could from the prognostications.
The Office of Fair Trading representative demonstrated his “without the profession” experience when he suggested that it was “inevitable” that the Government would have to address the open-ended NHS contracts under which the majority of dental practitioner providers currently work. Pointing out that such an arrangement was unique, he declined to give a precise opinion on the length of said fixed term contracts, but seven to 10 years was mentioned somewhere.
Unsurprisingly, the dental panel members retorted that the amounts now necessary to fund a modern and compliant dental surgery were more akin to a mortgage than a short-term loan, and that such a period was wholly inadequate for small businesses with significant overheads, never mind the funding repayment.
This observer was also struck by the widespread use amongst the panel of the word “phasing” in relation to a new contract. It does now seem to be flavour of the month. What particular bits of the ‘registration, capitation and quality’ approach could be brought in piecemeal still evade me.
In order to get on a care pathway, there needs to be a full initial clinical assessment. That will require investment in time, IT and training. It seems difficult to separate one from the other. Transitional guarantees will also be needed to avoid significant gaps opening up in the financial paving slabs as we migrate, however gradually, from one system to the next.
Quote of the morning had to be “If skill-mix is the answer, can someone remind me what the question was?” whilst some might feel this portrayed a rather dentist-centric approach, it did perhaps concentrate the mind on the unnerving speed with which direct access was introduced.
The concept, of delegating care and treatment to the appropriate level of skill and lawful practice, is eminently sensible from a cost-benefit viewpoint. I for one would far rather that my routine periodontal needs were dealt with by my hygienist than my dentist (no offence Doctor, if you’re reading this) and if there was a therapist on hand, I’d be happy to have my routine restorations done by him or her.
However, this does rather assume that there is sufficient complex treatment to be commissioned (publically or privately), planned and delivered at one end of the scale (with the attendant need for expert or specialist practitioners), and sufficient patient awareness to have routine or preventive work to be provided at the other end. Given that attendance is more or less plateaued and austerity is the prediction, is this the time to be significantly diversifying and growing the workforce at the same time?
Another hot topic – mixing – also enjoyed a raised profile, and there are enough straws in the wind to suggest that this is more than a passing emphasis. One speaker drew attention to the adjoining, and seemingly contradictory, clauses in the dental contract which, on the one hand, allow the provision of private treatment to an NHS patient, whilst tying the other hand firmly behind the dentist’s back.
If the doctrine of patients’ autonomy and freedom of choice is trumped by the requirement to advise them that treatment - of equivalent quality - is available at a lower price, that’s going to be a difficult if not impossible conversation to have, and one can only sympathise with those who have tried, and failed, to find the exact words and clinical notes to manage such encounters without falling foul of one regulator or another.
Maybe the hot spell is only transient, but the climate of professional debate shows signs of global warming. Mind you, I thought that in 1976.