The Only GDP on an Integrated Care Board
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- Published: Tuesday, 25 March 2025 09:49
- Written by Peter Ingle
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The change to having Integrated Care Boards commissioning primary dental care was always going to offer as many threats as opportunities.
The potential for decisions to be better tailored to local needs, and potentially facilitating more ‘joined up’ healthcare has considerable appeal. Against that there is a possibility of dentistry being squeezed out of decisions, and budgets.
One answer would be to have dentists represented within ICB’s at board level. Former CDO, Sara Hurley, a Non-Executive Director at Surrey Heartlands, was keen for more dentists to get a seat at their ICB’s table. Despite this, at the time of writing there is just one GDP sitting on an ICB.
Dr N. Tony Ahmed is the Local Dental Network (LDN) Chair for Shropshire and Staffordshire and England’s only dental professional on any Integrated Care Board.
Speaking to GDPUK he gave his unvarnished views not only on working with ICB’s, but the state of dentistry in 2025, particularly within the NHS.
We began by expressing some surprise about his forthright comments in a recent interview in BDJ In Practice. He had pulled no punches when it came to why dentists found NHS work unattractive, as well as some of the unnecessary obstructions faced by all dentists.
Tony was unapologetic, “No one’s coming out to say it. I thought it had to be said.” He has referred to dentistry’s three regulators, the GDC, CQC, and for those in the NHS, commissioners. The CQC in his opinion lacked the “soft intelligence” that Dental Practice Advisors (DPAs) had. Their methods of assessment made it possible for poor practices to get a glowing report, which did not necessarily reflect accurately on how the practice worked.
Anecdotally, it appeared that many commissioners had also come to the conclusion that DPA’s could offer much more valuable intelligence then the CQC, who in Tony’s opinion were not able to oversee general dental practice. Indeed they were failing to protect the public, and at the same time making it more challenging to deliver care.
His views on the problems faced by NHS dentistry, as well as possible paths to improvement, have been framed by his experience in dental practice. The Pandemic, or at least the phased return to work had given NHS dentists a “taste of freedom.” For a while dentists had been able to “stop counting the beans” and many had rediscovered their love for their work during that time when the UDA treadmill ran at reduced speed. Similarly, the pilots and prototypes with their more prevention focussed ways of working, had for a while, offered a taste of a better way of working. As Tony explained, dentists’ increasing disaffection with the NHS is not, “just about the money.”
With NHS dentistry already unattractive to many clinicians, aside from the contract, there were other needless challenges dentists faced. The difficulties typified by the obstacles in accessing occupational health, the delays and complications that must be negotiated to get a Performer number, all added to the picture of a service that didn’t particularly want dentists.
It was no surprise that commissioners were getting so many contracts returned or requests for rebasing, and they too were increasingly aware that money was not the whole problem.
Pragmatically, Tony took the view that efforts might be most productive in retaining dentists still in the NHS rather than winning back those who had already left. It was little surprise that many young dentists saw little future in the NHS and were planning their exit strategy at an early stage of their careers.
He was alarmed by the number of disillusioned FD’s that he met who were struggling at the prospect of a career delivering NHS, or even other models of dentistry. He had some practical words of advice for those young dentists. They needed to get the dentistry right first, the money will then always follow. Or as he put it, “Stop chasing the money and look after the patients!” He explained that this is an application of Walson’s Law, used in Business. New dentists when they first qualify are too motivated by the money, social media has a lot to answer for this.
Looking ahead we asked Tony what he felt might be deliverable on contract reform. However desirable it might be, he is not holding out for an increase in funding. The existing dental budget will have to be used more wisely and targeted to disadvantaged groups. There must be “difficult conversations.” He personally had no strong opinions, but this might mean a service with less interest in routine work, doing the best that can be achieved with the limited resources available, and more focussed on oral health and those in greatest need.
“Although the road ahead may seem daunting, it is essential that we approach the future with a sense of determination and purpose. Let us continue to stand together, support one another, and work towards a future where the challenges we currently face become catalysts for positive change.” And his final observation: “Dentistry is Team Sport”.
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