The reform treadmill

Dentists who worked in the NHS prior to 2006 will be familiar with the idea of treadmill. Sadly this wasn’t a euphemism for a specially discounted gym membership for NHS dentists, it was a common reference to the way that dentists worked in an activity based system. It’s hard to explain to a lay audience what has really changed. We used to fill out lots of forms and get paid based on how much treatment we carried out, we still have to fill out lots of forms and still get paid based on the amount of treatment we carry out. A few things have changed, for example we no longer have patient registration and don’t have responsibility for our own out-of-hours services. Patients are presented with a simpler charging system and unlike the old system they now only pay one of three charges.

Have we gone from treadmill to merry-go-round? NHS reforms are never ending and as politics become more sophisticated and as the health system creaks towards capacity the rate of reform seems to be increasing. It can sometimes feel like a never ending cycle which we should probably expect but it’s the rate at which we reach the change point which is becoming quicker. The current set of reforms are being marketed as ‘dental reforms’ as opposed to the creation of a new contract, this is really just semantics as a contract which is different to its predecessor is new. This set of reforms appears to be aiming to improve oral health and increase access. There seems to be an emphasis on improving the oral health of children, which always go down well politically. The technical aims seem much more definitive as the reforms intend to introduce some capitation, quality and registration.