We’re now a few weeks into the new health system in England. The last two months have been a mixture of opportunity and chaos which is not unexpected with such large scale change. Most patients will not have experienced any real difference at the front line, and those visiting an NHS dentist will probably have received the same care and attention that they would have done in March. Already, organisations have changed their names. For example, Clinical Commissioning Groups have adopted the prefix NHS; and the NHS Commissioning Board has been rebranded as NHS England. However these changes in name are unlikely to make any real difference to the delivery of care for patients in a dental setting.
One of the bigger changes for dentistry is that the chief dental officer (CDO) in England has moved from the Department of Health into NHS England. You may wonder what the significance of this is but in some ways it is the first time in recent years that the NHS will have some degree of independence from the Minister for Health.
The chief professional officers, including the CDO, will now be aligned to the Medical Directorate within NHS England and will have a greater degree of independence from the Government. NHS England will be overseen by a board where as the Department of Health is overseen by the Minister. However, NHS England and its officers will still be accountable to Parliament, like any other public body. The CDO in England, will now be part of the same organisation which will commission and contract NHS dental services. This is another significant change and removes many of the layers that existed between primary care trusts and the Department of Health.
The other major change will be separation of public health dentistry from the NHS. The responsibility for delivery of dental public health will pass to local authorities in England, although it may be delivered on behalf of local authorities by NHS providers. However, in the future it is possible that local authorities could retender these services. The advisory function of dental public health has moved to Public Health England. This will mean that public health dentistry is technically outside the NHS. Similarly, the postgraduate dental deans will have moved out of strategic health authorities and into local education and training boards which are part of Health Education England.
It does mean that the development of dental policy in the UK could now change. The Ministers and their senior team could go to any one of three organisations to seek advice on elements of dentistry. Whilst it is expected that all dentists working in strategic positions within the state will work together, it is entirely possible that the public health dentists or the postgraduate dental deans could provide independent advice that may even differ from that provided by NHS England.
What this has to do with those of us in some form of clinical practice treating patients? For patients it means that there are other advocates in English health system that are independent of the commissioners. In order to get the most for patients and to secure a stable practising environment the profession needs to act strategically and engage with the three new organisations in England. In my view, it’s not the names of the organisations that matter but whether or not the post holders will use their new positions to make a difference to patients receiving dentistry.