We are fast approaching an important junction in NHS dentistry, not only do we have a new chief dental officer in
England but we will also have a new Government. It’s difficult to ignore the political heat around the NHS and its importance to the public. Public opinion about the NHS and policy is likely to be one of the main deciding factors during the election. There has been much debate about public services and the role of private providers, and it has been interesting that much of the discussion has focussed on the legal status of providers as opposed to quality, safety and governance. Some of you will also have read the Five Year Forward View that sets out the vision of the most recent chief executive of the NHS in England. This is an interesting read and whilst dentistry does not get a specific mention, it’s also possible to see how dentistry could become part of the solution to the challenges likely to be faced by a future NHS.
The new CDO in England is likely to have a fairly full agenda given the political challenges of this role and also the changing expectations from the health system. Dentistry is not immune to the challenges in the rest of health care, for example availability and access to urgent and emergency dentistry. It appears that dental services are also affected by a combination of gaps in out of hours access and changing demands from the population. It may only be a matter of time before 8am to 8pm access in primary care comes to NHS dentistry in the same was as it is in general medical practice.
Integration of services is another ideal that is probably in the same box as whole systems delivery. It sounds great and lots of people talk about it but it seems it is still poorly defined in dentistry. NHS England and various stakeholder groups have been working hard to develop a suite of commissioning guides but it remains to be seen whether these new guides will offer real system change and whether or not NHS England will deal with the postcode lottery within its own organisation. It does seem ludicrous that NHS England is one organisation, yet different area teams have completely different approaches to commissioning specialised services.
The dental workforce is an ongoing issue that has caused much contention in the last few years. The understanding
and implementation of direct access combined with the oversupply of dentists remains a complex challenge for Health Education England and the regulators. Dentistry has a different supply problem to medicine given that there is probably an oversupply of general dental practitioners.
Alongside all the commissioning issues both in services and workforce, there is also the question of contract reform. It still seems like contract reform is occurring in isolation and debate is ongoing as to whether the Government is really taking GDPs on their journey and, more importantly, whether or not the wider public are also being involved. This type of engagement and involvement has to be more than a few special interest groups or self-selected individuals but a much broader type of involvement.
We may also be faced with another possible reorganisation in NHS commissioning as CCGs and NHS England figure out what they mean by co-commissioning and try to come to grips with the role of local professional networks.
In my view the NHS is not short of big strategic challenges and we can only hope that a new CDO has the skills, understanding and determination to take the public and profession on a journey of transformational change.