As the dental profession prepares for the outcome of England’s NHS dental contract consultation, dentist Mohsan Ahmad explores what he thinks needs to happen to protect the future of dentistry in the health service.
Whenever I speak to colleagues that offer NHS dental services, the most common feedback I get is that they don’t feel valued or listened to. It was felt almost straight away that the UDA contract wasn’t fit to support the oral health needs of the population, with preventive care not being appropriately funded.
Even when this was vocalised through the professional bodies, it seemed to land on deaf ears. NHS dentistry should empower dental teams to feel confident they are providing the most appropriate treatment to patients with significant emphasis on prevention and patient ownership of self-care. This is especially pertinent for patients that have high dental needs and irregular attendance at dental practices.
We need to ensure career pathways so that dentists can specialise and develop long‐term NHS careers, rather than use NHS work as a stepping stone to private only. Appropriately funded tier 2 services and opportunities in all the disciplines of dentistry is a must to ensure dentists can continue to deliver more complex treatments.
We also need a contract that better reflects the real cost of providing care (labour, materials, overheads) so that NHS work is financially viable. As such, the dental uplift should incorporate these costs fully and not less than what is advised.
What stood out in the consultation?
The care pathways proposed in July’s consultation move towards treatment that is more appropriate for high-risk patients rather than a banded system that hasn’t really worked for the best part of 20 years. There are opportunities to be able to bring the wider dental team members into the treatment of these patients, without practices being penalised financially because of how the course of treatment are paid currently.
Utilising a nurse with appropriate extended duties to support prevention and application of a licensed fluoride varnish will also make these team members feel more valued and further develop their career pathways.
However, the profession is still waiting for clarity on top-up fees following the GDC vs Williams case. If permitted, it would allow dental teams to provide more diverse treatment options for their patients, as well as giving patients more treatment options. Dental laboratories would also be able to charge more appropriately, as the charge would be passed onto the patient.
Seniority and loyalty payments could also be considered, going to dentists based on the number of years they have been providing NHS dental services and sessions they deliver. This would help in making dentists feel more valued and confident in offering NHS dental services.
Flexible commissioning to utilise the full NHS dental budget should also be considered. Over too many years have we witnessed ‘red tape’ preventing local ICB commissioners from utilising their dental budget to the maximum because of financial holes in other parts of the system. We should be utilising their local knowledge, as well as local dental networks and consultants in dental public health, to identify where the dental needs are.
It could also help to rapidly deliver a mix of recurrent and non-recurrent funding models to treat those oral health inequalities. Most areas already have these models tried and tested from previous years, but unfortunately are unable to pass go, because finance says no!
