In dentistry we’re often presented with technology changes either in the form of new drugs, clinical equipment or diagnostic equipment. It’s less often that we are presented with real technological innovations in terms of patient management systems. Practice management and patient record systems continue to exist, however they have not changed significantly in the last 10 years and they all still perform similar functions (mainly recording patient demographic and clinical information). In dentistry the processes and mechanisms by which we communicate with
other practices, referral centres and specialists is still fairly crude and is either reliant on paper or very simple
word processed forms.
The NHS has continued to invest in developing software and technical solutions for hospitals, community services and GP practices for a number of years. The recent need to improve efficiency in the health service due to financial constraints has only increased the drive to develop systems. GPs and their affiliated commissioners, both CCGs and NHS England, have recognised the efficiency savings that are to be gained from electronic prescribing, shared patient records and digital referral processes. This is where NHS dentistry lags behind and there do not appear to be any obvious plans to change the status quo.
There are few clinicians that would disagree with improving patient care through better co-ordination between healthcare providers. We’ve all probably been in that situation where patients have forgotten which medication they are taking for certain conditions, or where a patient has forgotten their most recent blood tests. It can also be frustrating when a patient needs a referral which requires completion of extensive information that has to be copied from a system into a form. Technology and the ability to link systems is not new and is used in other industries all the time - we probably use this technology in our personal lives in some form, be it banking, retail or ordering a taxi!
Historically, informatics within the NHS has consisted of centrally coordinated strategies with local delivery. This approach does not appear to have changed in the most recent iteration of the NHS, and NHS England is still working with GPs, pharmacists and urgent care providers to develop systems and improve connectivity. The most recent developments have included full health record integrations between primary and secondary care as well as the ability to electronically prescribe.
GPs already use digital referral solutions such as ‘choose and book’; as they are often on the N3 network this is much easier to co-ordinate than for NHS dentists. However, there are now solutions that allow connectivity between different networks and can overcome the barriers between N3 and non-N3 networks. Despite NHS England being one organisation, different area teams seem to be creating different solutions which lack central standards and are each being developed in isolation. It’s debatable as to how much technical expertise they are using to make decisions about whether to support one system or another. The problem for practices is that often their patients span administrative boundaries and it’s extremely inefficient having different referral mechanisms for different areas.
NHS dentistry seems to lack an IT strategy. Whilst individual software providers are making some operational
changes to accommodate possible changes to NHS contracts these don’t seem very ambitious when compared
to other parts of the health industry. Any form of IT development will require investment and this seems to be
lacking in NHS dentistry. Whilst there has been a lot of focus on seeing more NHS patients, there comes a point
where investment is needed in the infrastructure that supports this work.
In my view, NHS dentistry needs an IT strategy which will break down the technical barriers between dentistry and the rest of the health service. This needs to also reduce the variation between area teams and provide a vision for how NHS practices could operate in the future. NHS dental services need IT investment and policy makers need to make the case for improving the quality of services through this type of investment.