NHS England has started the process of setting its next agenda. This could be the start of a consistent approach to commissioning and delivering services to meet the needs of our patients. There have been times over the last few years when every conference or event about dental policy has used the themes of collaboration, stakeholder engagement and innovation. The ‘call to action’ is the most recent addition to the NHS suite of consultations, and dentistry has its very own call.
NHS England describes this as a request to patients, public, staff and partners to join a national conversation about the future demand on NHS services and the impact of changing health needs; and then how the NHS will meet these. Arguably this may not be the easiest slide deck to distil and it may even be difficult for members of the public to understand all the content but the underlying concepts do seem very relevant and hopefully a lot of patients and dentists will respond. Like me, some of you may remember NHS Dentistry: Options for Change and when reading the information pack for the ‘call to action’, there do appear to be some similarities between the current key challenges and the main findings from Options for Change.
Access in primary care has been a focus for the NHS for a large part of the last decade. This focus has attracted funding which many PCTs invested in dental practices, albeit through commissioning dental activity. Irrespective of views on activity targets, I expect most people would agree that this investment was positive. The measure for access in the NHS is usually unique patients seen in the previous 24 months, whilst this is one method of framing access it may be that patients and the public take a different approach to viewing access. Most people will probably think of access from their own perspective as patients.
I was recently shown an example of different referral forms for specialised endodontics from different parts of the country, what struck me was that these different forms each contained different acceptance criteria; some of the forms appeared to exclude or restrict access to molar root treatment whilst others had a number of barriers in place. It could be that this may be considered a health inequality where the underlying cause is geography or post code.
Similarly a health inequality may result from access to orthodontics as result of patient age. In some parts of the country patients are treated based on their clinical presentation and their need, in other areas access to orthodontics for adult patients has additional barriers. This approach seems inconsistent with recent equality legislation and could be an aspect of dentistry that NHS England helps standardise to avoid postcode driven decisions.
Access to minor oral surgery may also be an example of an inequality, where patients are accepted or rejected based on the location of their GP. This is another inequality which has resulted from artificial administrative boundaries created by the health system and perhaps something that NHS England could easily resolve to ensure that commissioners reach consistent decisions.
Out of hours dental services are also very different across England. NHS Direct’s Dental Nurse Assessment was a separate service which gave dental callers access to a dental nurse for advice and signposting 24 hours a day, just like other health services. From April 2014, the service will cease to operate with no replacement in sight. Therefore callers who are unfortunate enough to require dental advice late at night will simply have to wait until the morning or instead try their local emergency department. From a patient’s perspective, this may not be a very satisfactory situation.
In the last few years, there do not appear to have been any shortage of challenges in dentistry. In my view NHS England has an opportunity to listen and address these system wide issues, we need the profession and our patients to provide feedback and highlight all the challenges that exist in order to help NHS England prioritise and start a change process.