Many a wry dental smile will have been precipitated by the appearance of ‘dentistry’ Minister Lord Howe on the media recently over the NHS 111 affair. He was keen to point out that a pilot programme had been put in place in 2010 to test the system in advance of a roll-out in April 2013 – nearly three years. However, it seems that local primary care trusts were not really on the ball to evaluate the ability of the services they commissioned before they went ahead.
So, piloting is not really an absolute answer to anything, it seems, and Price-Competitive Tendering (PCT – yes really) which saw the cost of the new service fall from around £20 per call to NHS Direct, to between £7.50 to £8.50 did not deliver the desired quality. Quelle surprise, as they say.
PCT also reared its head recently in the débacle (sorry, very French this month) that has been the review of commissioning for criminal legal aid services. Here, the fee reduction proposed was so severe, that apparently only the largest legal chains with ‘economies of scale’ would be able to survive, while small practitioners with an excellent track record, would be left out in the cold. Another interesting parallel there you might think.
It’s so easy to forget that what you learn in one field of public commissioning can be readily imposed in another and then be shocked when the same result occurs. It was Einstein who said: “Insanity is doing the same thing over and over again and expecting different results.”
It’s been something of a melt-down time in healthcare as a poll of GPs proved in late July. A straw poll of 440 family doctors came up with the unsurprising finding that just over half were now in favour of a ‘small fee’ for appointments. This was up from one third in summer 2012, and the result set off the panic alarms in many medics’ minds. One commented: “Absolutely unbelievable, the NHS was fundamentally set up to provide healthcare for all not for those who could afford it, and indirectly all working people already pay for those appointments through their tax.”
Well, now, apart from the fact that it’s been evident for about 62 years that this is not universally true in other areas of the NHS (I could name one), another Doc noted that this survey might be the first step towards: “what dentists did when their contract was unfair”. He added that he: “knows dentists who earn £9,000 for a two day week”, but didn’t say whether this was per week, per month or per year.
Before dismissing these views, it’s interesting to see that while NHS England would like to increase dental access still further, Deloitte has predicted that GP appointment demand from patients will double over the next 20 years. I always remember that in the end, the politicians will have their way, arms-length bodies notwithstanding. As Aneurin Bevan said to the Cabinet in 1949: “The dentists soured public opinion by their behaviour. We couldn’t have got their co-operation at lower fees. We allowed them to misbehave to get atmosphere for a cut. Now cutting [fees] 40 per cent.”
Having said that, I wasn’t actually around (well not paying attention anyway) in 1949, but memories are short aren’t they? In that context perhaps the most potentially important note was struck by researchers at the University of Central Lancashire who found antibodies to Porphyromonas gingivalis in the brain tissue of four out of 10 Alzheimer’s sufferers post mortem. No control (healthy) brains showed this reaction.
This is hardly suggestive of a causative relationship, or even a profound link (at least until replicated elsewhere). Most experts agree that dementia has most probably a multi-faceted aetiology, however these findings add further weight to the notion that oral health is intimately linked to general health. P. gingivalis is most commonly found in large numbers in periodontal pockets and I can’t imagine a more emotive reason to contribute to encouraging better oral hygiene and lower risks for dental disease.
It’s interesting to speculate (and this is just speculation) that when the Adult Dental Health Surveys started in 1968, 37 per cent of adults were edentulous, and edentate mouths have no periodontal disease. Now it’s just six per cent. Which reminds me, where did I put my calculator?