The Select Committee Report - More Analysis
- Details
- Published: Monday, 24 July 2023 10:03
- Written by Peter Ingle
- Hits: 1846
47 pages, 2 days of hearings, 80 written submissions, 11 MP’s, a support team of 11 administrators and staff, 12 live witnesses, and then what?
GDPUK readers will be familiar with many of the arguments heard at the Select Committee, or to give it its full title, the House of Commons Health and Social Care Committee inquiry into NHS dentistry. For the MPs, the state of NHS dentistry is a sporadic irritant in their postbags and in-boxes, but for many dental teams it is their day to day life. For those able to spare a few moments in between seeing patients and all the other delights of practice, here are some of the key conclusions and recommendations.
These are covered under the four headings of access, the contract, workforce, and Integrated Care Systems.
“We believe there is a crisis of access in NHS dentistry” is the uncompromising beginning of the first section. Toothless in England will be pleased to read that: “We believe everyone should be able to access an NHS dentist when they need one, wherever they live.” It will not be an opinion welcome at The Treasury, who are used to budgeting for just 50% of the population. Welcoming the Governments ambition to improve access the report says that they, “must set out how they intend to realise this ambition and what the timeline will be for delivery. This needs to be, “a central tenet of the Government’s forthcoming dental recovery plan.” Suggesting that the Committee will be evaluating the plan when it finally arrives they add, “Once the plan has been published, we will revisit the recommendations in this report to assess it against this criteria.”
There is a call for better public information regarding registration, recalls, charges and exemptions. The report recommends that adherence to NICE recall intervals of up to two years should be monitored by NHS England to ensure compliance, so any such public education programme cannot come too soon for reception teams.
The contract section begins with a consideration of the fate of clawback funds. In contrast to the former CDO’s less than rosy view of ICB’s likely compliance, the Committee welcome the ring fencing to any underspend in 2023/2024, and ask that it becomes a permanent feature.
In a key section the report states that: “Fundamental reform of the dental contract is essential and must be urgently implemented, not only to address the crisis of access in the short-term, but to ensure a more sustainable, equitable and prevention-focussed system for the future. We are concerned that any further delay will lead to more dentists leaving the NHS and exacerbate the issues patients are experiencing with accessing services.” Those able to remember the previous 2008 Select Committee report on dental services, may have feelings of déjà vu at this point.
A move away from UDA’s with weighted capitation is recommended, crucially “in full consultation with the dental profession.” Repeating a recommendation from 2008, there should be a system of registration with NHS dentists.
The Committee sat before the NHS long term workforce plan had been revealed. It recognised that the amount of time that the workforce spent delivering NHS care needed to be established, and called for a survey to provide proper data. Such was its importance that it needed to be part of the recovery plan. Going on to recognise the damage already done, the report said that, “Any contract reform now will almost certainly be too late for those dentists who have already left the NHS or are considering doing so in the near future.” This added to the demand for urgent action to attract and retain dentists to do NHS work. There were also calls for greater use of skill mix, and the backlog for the Overseas Registration Exam was described as “unacceptable.” Centres for Dental Development such as the one the former CDO is involved with at the University of Suffolk, “could have the potential to change how we approach training dentists in the UK to meet the needs of the populations who most require care.” However they were, “in their early stages and their outputs will need to be assessed.”
The controversial idea of a tie-in for new graduates was considered with the report urging NHS England and the Government to ensure full consultation with professionals and representative bodies. In any event its success would depend on fundamental contract reform.
In the fourth group of recommendations the report said: “The dental profession should be represented on Integrated Care Boards to ensure they have the necessary expertise to inform decision-making around contracting and flexible commissioning. This should include wider engagement with the profession locally, for example through Local Dental Committees and Local Dental Networks.” The Department’s rejection of the Select Committee’s recommendations in a report on ICS’s was criticised, and felt to be particularly relevant to NHS dentistry.
With ICB’s looking at local initiatives, some using clawback money, the report said that NHS England needed to provide clarity to ICBs about what flexibilities they had in commissioning NHS dental services.
Again and again the current contact provided a stumbling block to improvements whether it was around, access, workforce, or ICS initiatives. To quote the committee: “We are concerned that the absence of explicit mention of the dental contract in the Long Term Workforce Plan reflects the lack of priority given by the Government and NHS England to contract reform.”
You need to be logged in to leave comments.
Report