Every successive report about the NHS and dentistry makes some reference to workforce. The NHS also has an overriding focus on quality and safety. I am sure our patients all want some assurance that the dental workforce treating them are safe to practice and that the NHS has systems and processes in place to improve safety. Dentistry is largely surgical innature, even with computer aided clinical decision support systems most of dentistry still requires some form of intervention. It’s this interventional nature that results in many dental procedures being classified as exposure prone procedures.
There seems to be divergence between the NHS England position on quality and safety and the actions of policy makers within the organisation. Co-payments and surcharges in any healthcare system can act as barriers to access; it’s unlikely that this would be any different to healthcare workers that have to themselves pay a surcharge. Recently NHS England has issued a number of letters about its position on occupational health. The direction NHS England is moving in would result in dentists and their teams paying for access to certain elements of occupational health. For example, a dentist applying to the performers list would need to pay for clearance to join the list; similarly a provider would need to pay the costs of any practice staff requiring occupational health assessment.
Once again policy makers seem to demonstrate their lack of appreciation of the way dental practices deliver services. This policy agenda seems quite strange for a number of reasons. NHS general dental providers have traditionally had access to what was once PCT provided occupational health services and therefore the cost of delivering this service was captured within the PCT, either through the former PCT’s own provider arm or contracted out through another provider. It seems that policy makers are now attempting to indirectly re-charge this cost to NHS performers and providers without adding the additional resources to dental contracts. The move seems to be disproportionately unfair to primary care dental contractors given that most community and hospital providers receive resourcing either through their base contract or through the way their tariff is calculated.
The policy also seems to discourage the use of skill mix as dental providers will indirectly suffer a penalty for using
dental care professionals to deliver NHS services through having to pay the cost of occupational health assessment.
This policy is also unfair to young dentists and recent graduates who may be applying to join the performers list for the first time. Colleagues such as foundation dentists have relatively low salaries, yet could be expected to pay for
occupational health clearance.
Whilst NHS England wants to move towards standard operating frameworks it does seem somewhat bizarre to treat all primary care providers the same irrespective of whether they are delivering dentistry or medicine. The surgical nature of dentistry would pose a higher occupational health risk to dentists and their teams in the NHS compared to colleagues in GP practice. Also in dentistry, unlike in general medical practice our teams are often involved with direct patient care whether that’s handling instruments or actually providing certain aspects of care.
We all accept that within the UK the risk of transmission of blood borne viruses through healthcare is relatively low, however that in itself is not a reasonor justification to erode away services that ultimately improve the quality of dentistry and more importantly improve safety. It does seem strange that when Public Health England recommends
policies that are inclusive (for example access to HIV treatment services for those entering the UK from abroad and
other initiatives such as supporting the Ebola outbreak in West Africa) that NHS England’s policies towards protection of the public move in the opposite direction and are increasingly more restrictive. The NHS England policy seems to ignore good practice that was developed in some areas through PCTs and instead move the whole country to a watered down service.
In my view, NHS England needs to reconsider this blanket policy and instead of introducing more barriers to occupational health it should be working towards creating a model that reflects the operating environment within NHS dentistry with improved access to services learning from best practice.