With the country’s finances in such trouble, it is inevitable that the budget cuts and fiscal policies being introduced by the coalition Government will have profound effects on dentistry in the years to come. The effects of these budget cuts will be felt in many ways.
As primary care trust budgets are being pared back, some areas of the country have had their dental tenders abandoned completely to save money and preserve funds. These tenders, which were commissioned to increase access to NHS dentistry following the results of population needs assessments which concluded that access needed to be improved, have been closed – in complete contradiction to the Government’s declared aim of increasing access.
The rise in VAT to 20 per cent will also affect dental practices. As dentistry is a VAT-exempt service, dentists will have to absorb this additional cost at a time when expenses have already rocketed for the reasons I have outlined in this column over the past few months. NHS practices are obviously unable to increase their prices to reflect this added expense, but I think private practitioners may also feel unable to increase their fees when their patients may be feeling the pinch in a time when job security is a concern and when patients too are faced with rising costs associated with the increase in VAT.
Patients have less disposable income in these austere times, or are choosing not to spend what money they have so this too has an impact on practice incomes. Practices which were undertaking many large smile ‘make-over’ cases and cosmetic treatments are finding that the number of patients requesting such treatments have reduced dramatically.
Health secretary Andrew Lansley’s white paper, Equity and excellence: liberating the NHS, set out the Government’s proposals for the planned loss of primary care trusts as part of a fundamental restructuring of the NHS. He said abolishing PCTs would save £1bn. As a result of this drive to cut costs, the teams that were formed to manage healthcare services on a local level will be disbanded from April 2013. This will result in the loss of relationships built over time between local commissioners and dentists when the new NHS Commissioning Board takes over from the PCTs.
Apart from the inevitable repercussions of the Government’s financial policies, more changes are on their way for dentists in England as a new dental contract is due to be piloted from April this year. The pilots will be based on a capitation and quality payment system, which will replace the much-despised units of dental activity. Government policy will be to introduce registration in a new national contract, but this will not form part of the pilots. Unfortunately, however, the patient charge system currently operating cannot be altered for the pilots. This is because (according to the Government) an alteration in the patient charge system would require a change in legislation and therefore would take too much time to implement. In my view, this will be a massive problem in the evaluation of the success of the pilots. If a revised system of patient charges is not assessed during the pilot phase, the whole pilot process could be a waste of time as the security of receiving patient charges is important for the Government in these financially compromised times. With patient charges making up a large proportion of dental funds, the Government will not want to face a shortfall in future.
As always, the system is in a state of flux. Only this time, the changes are taking place against a backdrop of financial uncertainty and budgetary cuts.