I sometimes wonder what NHS dentistry would look like if we could start again. Would we have the same workforce, commissioning arrangements and regulatory regime?
There seems to be no shortage of dentists and supply from both the UK and abroad appears to meet demand. What seems odd is that we have known that dental needs have been falling but as a country have been producing an increasing number of dentists each year. It raises a question about whether the training of more dentists is more about the sustainability of the teaching hospitals or whether it’s in the interests of the population. Each year we continue to produce more and more hygienists and therapists, yet very few of them deliver services for the NHS despite their training being fully funded. The potential oversupply of dentists and under utilisation of dental care professionals in the NHS just highlights the mismatch between population health needs and workforce planning.
Consultants in dental public health used to help commissioners in balancing the different needs with the resources available and generally trying to keep everyone happy. Sadly, this rare breed seems to be coming even rarer to the point at which they could become extinct. These individuals were in the unique position of understanding population level oral health needs, provision of clinical services and commissioning. The risk is that in the future, commissioners will not be able to draw on the expertise of these individuals as they simply won’t exist. It’s understandable that the organisational boundaries between the NHS and Public Health England are contributing to this issue but surprising that the Government allows this to persist.
The inspection of quality in dental practice is a complex business and within the NHS existed to some degree before the CQC was invented. It’s hard to understand how the CQC added value to the inspection of NHS practices that was already carried out by the PCTs. Whilst the PCTs may not have always been consistent in their approach and the training and experience of practice advisors was variable across the country, they did still exist. Therefore for
NHS practices the CQC did little more than to create a cost pressure without sufficient added value. Already the CQC is proposing that it will change its inspection regime for dental practices, which indicates a climb down and recognition of the disproportionate perception of risk.
The local professional networks in England were seen to be a way of supporting commissioning of NHS dentistry and allowing all stakeholders to come together and express their views. However, the reality is that almost two years later some of these are yet to get off the ground. How can local practitioners around the country influence the commissioning of dentistry when the structures don’t exist? In the past this was possible through oral health advisory groups and similar committees but in the new system in England these have been disbanded with no replacement.
The NHS has changed from the cottage industry that existed during its inception. The GPs and hospital based specialists seem to have a much stronger emphasis on the development of clinical leadership and management which may be why their networks are stronger. The GPs have been able to take this to another level with the development of clinical commissioning groups. It seems that medicine’s poor cousin, dentistry, is lagging behind. The dental profession needs access to the right type of development to help the profession progress.
In my view the Government needs to return to a focus on population oral health needs and align the commissioning of services, supply or workforce and inspection to these needs; with greater emphasis on the development of leaders in the profession.