The Guardian Guide to Fixing NHS Dentistry
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- Published: Tuesday, 03 December 2024 08:10
- Written by Peter Ingle
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While there is a consensus that the UDA contract has failed, there is no agreement on what should replace it. With regular stories about the access crisis continuing to be a media staple, The Guardian has taken a look at alternative approaches to provide an NHS dental service. It is not so long since some of the options being proposed, would have been immediately discounted as unacceptable or politically impossible.
Headlined ‘Experts sink their teeth into England’s NHS dental care crisis’ the paper’s health policy editor began with the recent analysis by the National Audit Office (NAO) that concluded that the much vaunted dental recovery plan will not work as reported on GDPUK here.
The paper chose four experts to offer their thoughts. Louise Ansari, the chief executive of Healthwatch England, wanted a medical GP type right to register. Healthwatch urged the government to base their plans to improve NHS dentistry on the principle of giving people the right to register permanently with a dental practice, as they do with an NHS GP. This would, “help them access ongoing appointments and check ups and ensure continuity of care from a trusted professional.”
Louise Ansari said that the contract change in 2006 was a key reason for the loss of general access to NHS dental care, and that it was time to go back to the old system. How such a service would be delivered or paid for was not discussed.
The second option was very much in line with current NHS England thinking. Mark Dayan, a policy analyst at the Nuffield Trust health think tank, argued that for many individuals, regular dental examinations were unnecessary. One or even two years intervals were suggested. He cited the NICE view, saying that, “that a gap as long as two years was perfectly safe for many adults.” His solution to the resistance from regular attenders to such changes, was to have a public information campaign.
‘Ditch the dental contract’ was the third option. That it was unfit for purpose was something that Labour and the Conservatives, the Commons health select committee, the Nuffield Trust and the BDA could all agree on. The familiar failings were covered, and in its place the BDA wished to move to a system focusing on prevention and providing extra support to those with the poorest oral health. The paper pointed out that this was compatible with the direction set out in Lord Darzi’s review of the NHS from September 2024.
Mark Dayan and Shawn Charlwood, chair of the BDA’s general dental practice committee were enlisted to provide the last option, to overhaul the funding of NHS care. Reference was made to the money lost from the dental budget each year, something the NAO report had also highlighted. Dayan pointed out some of the flaws in the current contract and suggested a capitation model. The BDA was quoted as agreeing, and argued that replacing UDAs would help to fill the workforce vacancies in practices, which were running at 21%. “Fix a broken contract and fund this service properly and we can consign some of the horrors we’ve seen back to the Victorian era,” Shawn Charlwood said.
That ‘proper funding’ looks set to stay a stumbling block, and in its absence some of these solutions remain wishful thinking.
Firing from the hip
I wonder what evidence was looked at. Scotland has had lifelong registration for many years and while many are nominally registered, when it comes to actually getting an appointment the dental deserts north of the Tweed as just as arid as those in EnglandFiring from the hip
I wonder what evidence was looked at.Scotland has had lifelong registration for many years and while many are nominally registered, when it comes to actually getting an appointment the dental deserts north of the Tweed as just as arid as those of our southern neighbours.
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