It could be hard to believe that the UK is amidst one of the toughest series of public sector spending cuts in post-War history given that the Government announced that it is injecting almost £30m into NHS dentistry. At a time when there are almost daily reports of hospitals being bailed out and the discovery of previously unknown black holes in primary care trust finances, it is a brave Government that starts spending on National Health Service dentistry. It raises the question of how the Government managed to find the investment money and leaves some wondering whether the NHS actually under spent this year.
There has been a flurry of activity in PCT dental contracts teams recently. Part of the activity is just deciding what name they give themselves, are they contract managers or commissioners? The rest is about how to spend this cash injection before March 31, 2012, the end of the financial year.
What seems clear from those PCTs is that they have 'won' extra money for primary care dentistry and that they are obliged to have commissioned the activity this financial year, which would usually mean that the activity has to have been commenced this financial year. Therefore the public could not be blamed if they thought that this was more about balancing NHS finances than intentionally trying to improve access to NHS dentistry.
The mechanisms involved in deciding where this extra funding is allocated also seems a little unclear. The money seems to have followed PCTs demonstrating poor access, using the measure of proportion of unique patients seen in the preceding 24 months. However this measure is not a true measure of quality and in reality it masks the inequalities in access within a PCT area.
When overseas aid organisations and NGOs invest in the developing world they can be accused of lack of co-ordination and increasing bureaucracy as well as disrupting health economies. Most charities are well meaning but occasionally they visit a site and provide some short term support and investment in a health project and then move on to the next place. The criticism of this approach is that it can widen the gap in inequalities and it can also disrupt the local health economy. What these places need is sustainable investment that will improve the health of their populations in the longer term.
This analogy could be applied to the current scenario in the NHS. This well meaning investment will possibly provide some very short term gains and make 'access' figures look better but in the long term could be unsustainable, especially if new patients have high needs and require long term management.
It also seems that PCTs across the country are taking very different approaches as to how they procure this new activity. It is a matter for each PCT as to how they procure, however, it would be hoped that they all follow a fair process. What has become apparent is that different policies are emerging on the values ascribed to this new activity and the way in which they will measure the outcomes in relation to this new investment.
Dentists are generally technically skilled and innovative and no doubt they will work with their PCTs to help ensure that the activity is contracted and that they endeavour to deliver improvements in access. The question remains as to whether more investment will follow in the future or whether this is a one off injection designed to use up NHS underspend?