On Monday 22 August, Denplan welcomed Chief Dental Officer for England, Sara Hurley, and Andrew Taylor, her Dental Programme Manager, to the company’s head office in Winchester. The aim of the meeting was to explore areas of mutual interest between the private and public sectors. There was acknowledgment that engagement between the two sectors centres on common patient-centred goals – not least that of offering more patient choice, and improving the long term oral health of patients in the UK.

Henry Clover, Denplan’s Chief Dental Officer said: “We were delighted to welcome Sara and Andrew to our offices, where we were able to explain Denplan’s business model and the range of support services we offer to 6,500 member dentists nationwide. We see this as the start of a conversation on potential areas of collaboration and information sharing.”

One area of discussion was the Denplan Excel certification programme, developed over 15 years ago for dentists to help support clinical governance, professional regulation and excellence in patient care and communication. The Denplan Excel programme was also UKAS accredited in January this year. Denplan explained that they would be open to future discussions with the GDC regarding continuing assurance plans, and with the CQC, to discuss the potential value of clinical service accreditation and peer review schemes. These could be useful information sources to support their inspection programmes and to help continue driving up standards in dentistry.

Henry also shared some data recently published in the British Dental Journal which demonstrated that worsening oral health correlates with worsening general health. This was derived from over 37,000 patients who had received a Denplan PreViser Patient Assessment (DEPPA)¹. The research provided further evidence for the association between high-risk lifestyle factors such as smoking and heavy drinking and poor oral health outcomes in an area of common interest in all sectors of primary care.

There were also discussions around the array of tailor–made practice training sessions that Denplan runs for practices and their dental teams – over 450 sessions per year.  Denplan Academy training covers areas such as complaint handling, legal and ethical issues and GDC standards, preparing for CQC inspections, and caring for patients with dementia to name a few.

Henry said: “It was generally agreed that any initiatives and training that improves practice efficiency and in turn improves oral health outcomes, would serve the profession well to be explored on a wider scale.”

Sara also outlined the case for a national programme to improve dental health through better co-ordinated care and empowering communities to implement their own sustainable oral health initiatives.  She will be launching the concept of “Smile 4 Life” at the Health and Care Innovation Expo next month; national support for existing community based projects, a hub for sharing best practices across Local Government Authority areas and ensuring that local oral health initiatives are complemented by innovative commissioning approaches within local NHS England Commissioning Teams and supported by the profession. 

The initial focus is “Early Years/under 5’s” with the aim to provide opportunities for families and  children to establish good oral health habits as a daily norm, be it nursery school or at home.  With encouragement and ease of access to dental care professionals, first check-up by age 1 and opportunity to continue to visit the dental team regularly for age–appropriate preventive advice, together with help to ensure problems are identified early, the prospect of a generation of children free from decay becomes increasingly real. 

Keen to expand the concept of Smile 4 Life beyond childhood, Sara also touched on an ambition for a wide-ranging programme for oral health reform – with a focus on improvements for the oral health of the over 65’s, the 16-24 age group, the homeless, the ageing well (typically aged 35-55) and those aged 85 plus – a population expected to double between 2010 and 2030. She also expressed her determination that the dental profession work together to lead and achieve the required changes.

Henry commented: “Denplan will continue to support such prevention strategies that recognise that good dental health in childhood is vital, not only for lifelong oral wellbeing, but for good overall long term general health. This is ever more so important now, given the lack of an oral health focus in the government’s recently published obesity strategy.” 

^[1] http://www.nature.com/bdj/journal/v221/n2/full/sj.bdj.2016.525.html British Dental Journal 221, 65 - 69 (2016) Published online: 22 July 2016 | doi:10.1038/sj.bdj.2016.525

About Henry Clover

Henry Clover joined the Professional Services team of Denplan in 1998, having worked as a dentist for 17 years looking after patients’ oral health in his own practice. He now holds the position of Director of Dental Policy at Simplyhealth and is also Chief Dental Officer at Denplan. Henry playing a vital role in Simplyhealth’s Leadership Team and is at the forefront of private dentistry liaising with more than 6,500 member dentists.

About Denplan

Denplan is the UK’s leading dental payment plan specialist, with more than 6,500 member dentists nationwide caring for approximately 1.7 million registered patients. Established in 1986 by two dentists who pioneered the concept of dental payment plans, Denplan has been at the heart of dental care for nearly 30 years and today the company is owned by Simplyhealth. Denplan has a wide range of dental plans for adults and children, enabling patients to budget for their private dental care by spreading the cost through a fixed monthly fee. We support regular attendance and preventive care, reducing the need for clinical intervention and helping patients to maintain healthy teeth and gums for life.

For further information visit www.denplan.co.uk. For oral health tips and advice visit www.myteeth.co.uk. Patient enquiries telephone: 0800 401 402   Dentist enquiries telephone: 0800 328 3223 
 

• Denplan Care: all routine and restorative care + worldwide dental injury and dental emergency cover
• Denplan Essentials: routine care only + worldwide dental injury and dental emergency cover
• Plans for Children: routine and other agreed care + worldwide dental injury and dental emergency cover
• Membership Plan: registered with the dentist + worldwide dental injury and dental emergency cover
• Denplan Emergency: worldwide dental injury and dental emergency cover only
• Company Dental Plans: company funded, voluntary and flexible benefit schemes 
   

Denplan also provides a range of professional services for its member dentists and their practice teams, including the Denplan Quality Programme, Denplan Excel Accreditation Programme and Denplan Training, plus regulatory advice, business and marketing consultancy services and networking opportunities.

The new Minister was being briefed by the new Permanent secretary, Lady Arabella Sternchin.

“Good morning Minister.”

“Good morning Arabella - it is OK for me to call you Arabella I hope? “

“Quite acceptable Minister.”

“Good I didn’t want to get off on the wrong foot. I heard that old Humphrey could be a stickler for protocol.”

“I never worked directly with him, Minister, so I was never more than ‘my dear girl’.”

“Well that’s all clear then. Now as we’re both new boys, what are we going to do to get rid of the dentists Arabella?”

“Ah yes, I have done some research.”

“Splendid. Burning the midnight oil what?”

“No Minister. Burning out interns. It seems that one your predecessors thought they had things sorted out a decade ago.”

“What was the intention?”

“Well they imposed a new contract that was so ridiculous, so half baked and so poor for all parties that no-one with any common sense would sign it.”

“What happened?”

“The dentists signed it. They ignored advice and signed in their droves. Now the doctors, as Mr Hunt is finding, love a fight, the BMA is a nasty opponent and of course people like doctors. We presumed that as it was so obvious the dentists would lose their clinical freedom and wouldn’t be able to do clever work they would say no and head for private practice. But no such luck.”

“That was 10 years ago though Arabella, haven’t we tried anything since?”

“We got this chap Cockcroft to tell everybody that everything was wonderful.”

“Oh yes I met him once - the shifty one who can’t look you in the eye?”

“That’s him. Well in spite of the fact that nobody ever believed a word he said, indeed quite the opposite, they all opted for to jam today instead of no bread tomorrow.”

“Didn’t we try anything else?”

“Yes we opted for ‘death by acronyms’, the civil servants’ foolproof fallback.”

“What did we use?”

“First there was something called HTM01 oh something, it was all to do with cross infection. We put it about that dental practices were death traps and full of all sorts of bugs. We backed it up with lecture tours by a couple of burned out bug counters and some research work by the manufacturers of some extraordinary things called washer disinfectors. They were really souped up dishwashers but had the lifespan of a mayfly. Did no end of good for our German chums who sold them and made the fang farriers pay for servicing. Fact finding trips to the Black Forest all round!”

“I remember that. What else?”

“Then we thought we would trial the CQC on them - totally inappropriate for their industry of course but it helped us prepare for the real targets, the GPs. We made them pay for our mistakes too - what a naive bunch these are.”

“Didn’t they smell a rat?”

“Sadly not at all, in fact they kept coming back for more. A bit like dental Oliver Twists, “give us more UDAs”, they said.” Then a stroke of genius, they sent Bill Moyes to the GDC.”

“What madman Moyes? He’s not still at large is he?”

“Oh yes indeed Minister and he’s on our side now.”

“So let me get this straight, the original plan was to freeze them out of the NHS, into the good old private sector. How would we placate the voters, you know the Daily Mail reading “we support the NHS” brigade? They vote for us you know.”

“Privatisation minister.”

“Shhhh! Keep your voice down. How?”

“You remember the Carlyle group?”

“What the chaps who sell guns and ammo? They’re so bad even the Yanks don’t like them. How did that work?”

“We arranged for lots of little practices to be bought by Carlyle.”

“Goodness that’s cunning - what did the dentists do?”

“Some of them especially those growing long in the tooth - if you’ll excuse the pun - hated these “corporates” with a vengeance, but they hated the CQC, GDC and so on even more.”

“That doesn’t sound too good.”

“Bear with me Minister.”

“Chance would be a fine thing.”

“Cheeky. It seemed that once these upright, responsible members of the profession saw the colour of Carlyle’s cash they couldn’t wait to trouser the money, roll over, mutter “what principles?" and head for the golf course to blow their lump sums on Rory McIlroy clubs and Audi estates”.

“Gosh - I wondered where old Keith the teeth went. He was my constituency’s BDA rep and a right royal pain in the posterior.

So where are we now?”

“It has proved such a success that the first thing on your desk - once we get rid of this Brexit thing of course - is to consider the idea that we let the Carlyle conglomerate have the whole dental, err, shooting match. It will stop us having to pretend to deal with that dreadful Armstrong man from the BDA, apparently everyone preferred Martin as he knew how to make a decent G&T but this fellow just drinks pints of real ale and keeps nipping out for fag breaks and, by the look of him, the odd pie or two.”

“Isn’t that a bit drastic?”

“Not at all if the Mancs can manage health care, then Dentistry is just nickel and dime stuff as the cousins would say.”

“Just like that?”

“Indeed, Brexit may be a fly in the ointment, however.”

“How so?”

“Keeping these dental sweat shops, sorry surgeries, manned depends upon foreigners who can’t find work in their own lands. At the moment they can get work here easier than our own graduates.”

“Is that fair?”

“What’s fair got to with it? When was a dentist ever fair with you?”

“Sorry Arabella, do continue.”

“Our graduates are so in debt, what with £45k of tuition fees and much the same in beer loans that they are starting to undercut Johnny dental foreigner.”

“Maggie would be proud.”

“Indeed Minister. But it doesn’t stop there. We have plans for the private dentists too.”

“What now?”

“The Dutch control the fees that these cruel b****** can charge so we plan to do that and also to introduce a compulsory insurance plan to match the fees. We started talking to Wesleyan and Simply Health a couple of years ago and they have been very active and are readying themselves.”

“Goodness you have been busy.”

“That’s just the start minister. Your next meeting this morning is with Nigel my colleague from education. We intend to liberate the dental schools from University control. It’s something that we have been working on for a decade - it was Blair who originally got the ball rolling.”

“You know Tony was a good man really, a shame he pretended to be a red and a bit too keen to press the button. But ethically one of us.”

“Instead of teaching the new dental apprentices in ivory towers they will go to urban silos or, as Peter Mandelson christened them, “outreach centres”. These will be run by Carlyle, using their new branding of “ToothSkool”, and the apprentices will learn on volunteer patients for the new three year course. The volunteers will get rewarded with beer vouchers and the children a sticky bun. We have no end of great people coming on board to sponsor these places. Coca-Cola, Tate & Lyle, Kraft Food, Tesco.”

“What fun….good lord Arabella there’s a seat in the Lords waiting for you if this works out.”

Yes Minister.

Following similar campaigns for medicine and pharmacy, (no I hadn't noticed either), last week NHS England launched the dental call. It was trumpeted with documents with the admirable aim of improving dental care and oral health, but the large caveat is this must be done with a reducing budget and a £30 billion black hole in the NHS funding stream. One wonders if loosing dentistry from the NHS might infill some of the cavity.

We are told that the NHS dental budget is £3.4 billion per year and that private dentistry makes up £2.3 billion in provision, although some may dispute that. £653 million from patient charges is included in the total budget and is an important part of the contribution. In view of what the government is prepared to pay on other issues, one wonders why it is needed at all, but of course patient charges are a controlling factor of the demand.

Much is made of the Dental Local Professional Networks that have recently been established, but no mention of the chronic underfunding of this, which might explain why so few of us will have noticed their existence to date.

The NHS belongs to the people is the strap line, but not sure the way politicians interfere with it, make any of us feel like the owners.

The document attempts to describe many strengths in the current system and improve access. At a recent GDPC meeting I asked Elizabeth Lynam , head of dentistry at the DoH would there be funding for more patients to register if a reformed registration and capitation model attracted more than the 56% currently visiting practices in a 24 month period, no was the answer.

So if access is to increase, that too must happen within the existing budget. Not so much a call to action as a call for charity from the profession.

As a committed LDC official, I am disappointed that there is not a single reference to local representative committees, nor a mention of them being stakeholders. Perhaps with the manipulation of levy collection ongoing by NHS England maybe they won't be for long anyway?

We are asked to respond to the questions by the 16th May 2014 and that our answers will be independently analysed, we are not told by who,( I am lead to believe it may be an American institution, so much for tendering) but it will make a change for independent analysis when we are deprived that within the pilot programme. A strategic framework for commissioning will be published along with a report.

There is pride on the excellent data on disease and activity NHS England hold but those that witnessed the destruction of the Dental Practice Board will believe this information far inferior to what was previously known.

Again there is a plan to best use tax payer’s money and develop a workforce that is appropriate for the future, a bit rich after what graduates are facing in the lottery of FD placement. But world class has been replaced by exemplar commissioner so perhaps reality is dawning at Whitehall. I wonder where the "tools" to enable a consistent care pathway are being kept.

Remarkably the document admits they need to know how to measure excellence and despite telling us how good the data is they have, they admit they lack data to benchmark performance nationally. I know what I believe of these two versions on data.

In its section on health inequalities it talks about a "seldom heard" group, I got quite excited when I thought it might be the many critics of DoH and NHS England but it turns out to be patients facing barriers to accessing care.

There is a clear message they we carry out our care at times convenient to us, and that patients want extended hours after work and at weekends. Not sure what evidence base there is for this, but the direction of travel is clear.

Much is made of the OFT report of 2012 despite massive criticism from the profession and the BDA. So not much notice taken there then, and of course they trumpet this call to action process is being supported by the BDA. Damned if you do and the same if you don't .

There are also indicators to the shape of general practice of the future, they want to move away from working in isolation and support larger teams in the interest of better care, and develop special interest in primary care. The end of single handed practice and tiered delivery of care for those with the badge to do it is just a review away perhaps?

It is followed by a list of questions deliberately moulded to either restrict answers or get the ones they want, but none the less I would encourage all to let them have the "action" by going to

www.england.nhs.uk/ourwork/qual-clin-lead/calltoaction/dental-call-to-action/

Whilst I understand enthusiasm for this is not great and we are being herded along with the medics, we should not under estimate the importance or messages contained.

Eddie Crouch