Agenda item

Elaine Biddle (Compliance Manager, Care Quality Commission), Maureen Hall (Dental Contract Manager, NHS West Kent), Dr Tim Hogan (Chairman, Kent Local Dental Committee), Stephen Ingram (Director of Primary Care, NHS West Kent), Bill Millar (Head of Primary, Community and Elective Care Commissioning Directorate, NHS Eastern and Coastal Kent), Allan Pau (Specialist Registrar in Public Dental Health), and Paula Smith (Lead Commissioner for Max Fax, Orthodontics and Dental, NHS Eastern and Coastal Kent) were present for this item.

(1)       As a representative of the Local Dental Committee (LDC), an organisation with the stated aim of representing the interests of the dental profession and patients, Dr Tim Hogan outlined some of the challenges inherent to the current dental system. He believed that the present system pleased no one and that what was needed was one that concentrated on oral health prevention and administering the appropriate treatments while paying dentists appropriately without any perverse incentives.

(2)       Two main issues were identified concerning finance and the current system. Firstly there was the system of three bands which determined the cost to NHS patients who were not exempt from charges. Mr Ingram reported that charges typically only covered two-thirds the cost of actually delivering the treatment and dentists were paid by the Primary Care Trust (PCT) for delivering Units of Dental Activity (UDAs). Dentists received a certain amount of money for each UDA and the income of the dentist was the difference between the dental charge and the money received for the number of UDAs involved. This was complicated by the value of a UDA being different for different dentists.  Dr Hogan gave the view of the LDC as being that this system achieved the opposite outcome of that intended.

(3)       The second issue was that PCT allocations for dentistry were set on historical spending in 2006. Mr Ingram reported that if NHS West Kent received the average allocation, the money available to spend on dentistry would increase by 21%, or around £5 million.

(4)       Representatives of the NHS outlined how the Department of Health was currently piloting different models for a future NHS dentist contract and how dental commissioning would be carried out by the proposed NHS Commissioning Board. This led to a discussion on the merits of capitation forming part of any new system, with the idea of a pure capitation contract where dentists are paid based on the number of patients registered with them, not finding favour amongst Members of the Committee. Dr Hogan made the observation that some private insurance schemes were akin to capitation through having a monthly fee.

(5)       This led to a discussion on private dentistry and how it was unknown how much treatment was provided privately as these figures were not collected so the true levels of dental access were unknown. It was also difficult to determine whether there was a shortage of dentists or a shortage of dentists willing to provide NHS services under the current system. Dr Pau was able to report a recent survey in West Kent which revealed over 80% of people had visited a dentist within the previous 24 months. Several Members mentioned some specific local issues around access, which the NHS undertook to look into.

(6)       The LINk representatives on the Committee reported that they had received no complaints around access, although there was an issue around ensuring the information available on NHS Choice was kept up-to-date regarding what dental surgeries were open to new NHS patients.

(7)       Dentists are currently being registered by the Care Quality Commission (CQC) and no dentist will be able to practice after 1 April 2011 without having done so with the CQC having a range of inspection and enforcement powers. This will include private dentistry and it was acknowledged by the whole panel that this was a positive aspect.  There was some discussion around how much registration would benefit dentists in the context of professional regulation, but the counter point was made that registration was more about being in the interests of patients.

(8)       On prevention, there was a difference of emphasis between different members of the panel between those who felt the real preventive work needed to be undertaken by schools at an early stage and those who felt dentists had a more direct role to play in preventive dentistry. Several Members felt the schools angle was one they could explore further through other platforms within Kent County Council.