Within dentistry we may sometimes think about our customer, we probably always think about our patients and from time to time we may think of our customers as patients. The NHS is a bit different to most other sectors where the customer is defined by a product or that the product is differentiated for a customer.
Most companies and commercial organisations put a lot of time and effort into segmenting their customer base to find out who their customers are now or could be in the future.
They identify ways of grouping them and then following them through their business. This is not dissimilar to how most insurance companies risk-pool their subscribers and then set premiums based on those groupings. We all experience this too when we renew our indemnity each year and have to select the practising group that we belong to. This method of grouping is the same reason that different branches of the same retailer will know where to target certain products and services.
In NHS dentistry, we seem to have more than one customer and their intentions may not always overlap. We have those people who come to see us in our practices that are our patients and sometimes our customers and we also have that organisation that contracts our services which is
NHS England. In an ideal world, NHS England would reflect the needs of all the people around our practices and then contract our services based on those needs. However, it may be quite difficult for any organisation to identify the habits and patterns of the people living near each of our practices. To do that, they would need to know all the addresses of potential service users, something about their deprivation status and something about their health status and possibly something about their oral health status. The level of accuracy of the information would need to be good enough to be able to make good assumptions about those groupings of patients. The chances are that the NHS and the Government probably does have enough information from which it could draw such inferences if it was possible to link lots of data sets.
It seems that the evaluation of the pilot sites for changes to NHS dentistry are mainly based on how existing groups of patients access NHS dentistry, that is the current group of customers. These are the customers that are easiest to get to, perhaps those that are already familiar with the product of NHS dentistry or at least those that can easily be converted from the private sector. One of the intentions of the changes seemed to be increasing access, what is less clear is which customer segments were being targeted. If it was those groups that were hard to reach or that had not previously used an NHS dentist then the measure may have been calculated by tracking NHS numbers for ‘new’ patients. However, it seems unlikely that any pilot site has access to the NHS patient database from which it would be able to identify NHS numbers.
The NHS is constantly seeking to learn from the outside world and there are probably countless initiatives to train our leaders to seek ideas from commercial organisations. Companies such as Microsoft, Apple and Google are probably quite clear who it is they are targeting and what their methods are for doing so.
In my view, if we are going to design a new system around the needs of patients then not only do the mechanics of the contract need to work but it also needs to clear which groups of customer the new system has been designed to target.