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1

The Steele Report (June 2009)

affirmed that the profession's goal was to improve oral health and emphasised the need for better health outcomes through prevention.

2

aims for NHS dentistry

•To improve the oral health of the population, especially children, hard to reach and vulnerable groups, and to reduce inequalities of outcomes;
•to move to a more preventative approach based on the needs of the individual patient and the population focusing on:
– quality rather than activity
– outcomes of care, especially long term outcomes, rather than delivery of treatment
– continuity of care for patients over a longer period of time;
•Increased integration of care across primary, community and hospital settings;
•ensuring good and equitable access to NHS dentistry.

3

Our efficiency package for 2014/15 is expected to deliver savings across, national and local levels, in line with the rest of the NHS, some 4%, and includes:

•Reducing costs of unnecessary activity
•No increase in funding or weighting of courses of treatment to reflect increased complexity arising from demographic changes;
•Continuation of dental practice computerisation to enable the delivery of the new dental contractual reform proposals;
•Amending dental payments for maternity, paternity and sickness leave
•Reducing dental foundation trainee salaries over time to match the first post registration year for doctors to regain a level playing field in this area.

4

Dental Contracts and Agreements – uplifts for 14/15

In respect to General Dental Practitioners (GDPs), the government has accepted the DDRB’s recommendation for an increase of 1% to general dental practitioners’ income after allowing for movement in their expenses, but has abated the increase in the general dental service contract for the GDP staff costs element of the formula from the recommended 2.5% to 1%. This results in an overall uplift of 1.6% to be applied to gross earnings for i•claw back funding for excessive under-delivery of contract activity;
•move to a shorter return cycle for activity and performance data (which will also assist in moving to a capitation system);
•improved anti-fraud measures;
•reducing unnecessary dental referrals from primary to secondary dental care through increasing activity undertaken in primary care, supported by changes to remuneration structure and changes to reporting and monitoring arrangements.
independent dental contractors for 2014-15.

5

Reducing costs of unnecessary activity, through new measures to:

•claw back funding for excessive under-delivery of contract activity;
•move to a shorter return cycle for activity and performance data (which will also assist in moving to a capitation system);
•improved anti-fraud measures;
•reducing unnecessary dental referrals from primary to secondary dental care through increasing activity undertaken in primary care, supported by changes to remuneration structure and changes to reporting and monitorinLast summer NHS England published “The NHS belongs to the people – a call to action” which set out the challenges that this country faces in continuing to secure and improve high quality services in the face of demographic pressures and rising public expectations, against a backdrop of financial constraint.

6

Call To Action for Improving Dental Care and Oral Health:

Last summer NHS England published “The NHS belongs to the people – a call to action” which set out the challenges that this country faces in continuing to secure and improve high quality services in the face of demographic pressures and rising public expectations, against a backdrop of financial constraint.

• The subsequent ‘calls to action’ for general practice (August 2013) and community pharmacy (December 2013) have set out to stimulate debate in local communities – amongst everyone who works in health and social care or who uses the NHS. We asked how we, as a commissioning body, could best facilitate and support transformational change to the NHS that is nationally enabled but locally delivered.

7

Who can get involved?

Patients, patient groups, voluntary and community sector groups • Everyone who works in health and social care • Dental Local Professional Networks • Healthwatch organisations • Local authorities • Other providers of healthcare services • Professional organisations • Local education and training boards and academic health science networks

8

We will be guided by the five domains of the NHS Outcomes Framework, which exists to act as a catalyst for driving up quality throughout the NHS by encouraging a change in culture and behaviour:

preventing people from dying prematurely - enhancing quality of life for people with long term conditions - helping people to recover from episodes of ill health or following injury - ensuring that people have a positive experience of care - treating and caring for people in a safe environment and protecting them from avoidable harm

9

Describe the dental banding system

Band 1: £20.60 covers an examination, diagnosis and advice. If necessary, it also includes X-rays, a scale and polish, and planning for further treatment.

Band 2: £56.30 covers all treatment included in Band 1, plus additional treatment, such as fillings, root canal treatment and removing teeth (extractions).

Band 3: £244.30 covers all treatment included in Bands 1 and 2, plus more complex procedures, such as crowns, dentures and bridges.

10

2006 contract

The contract between the NHS and dentists determines what work is provided for under the NHS, payments to dentists, and charges to patients. The contract has been revised several times, covering more than just charges and prices. A contract introduced in 2006 was said by the British Dental Association in 2016 to be not fit for purpose, rewarding dentists for meeting government targets for treatment and repair, but not for improving patients' oral health

11

services

A local health authority dental service which provided dental inspection and treatment to school children, pre-school children and to pregnant women and mothers of infants under one year old, but is now chiefly Special needs dentistry. These were transferred to the NHS in the 1974 reorganisation. These services employed the whole-time equivalent of about 1,980 dental officers, assisted by 370 dental auxiliaries, 2,900 dental surgery assistants, 70 hygienists and 140 dental technicians in the UK in 1977. They were repeatedly reorganised, like other community services. Most were run by Primary Care Trusts until they were abolished in April 2013.[21]
A general practitioner service. Proposals for whole time salaried service at health centres came to nothing and almost all General Dental Practitioners are in private practice. Contracts were originally held by Local Executive Councils, and then by their successors Family Practitioner Committees, Family Health Services Authorities and Primary Care Trusts. They are now held by NHS England
A hospital dental service, with access to specialist maxillo-facial and oral surgeons. Managed originally by Regional Health Authorities they became part of NHS Trusts, mostly in teaching hospitals.

12

pay

Dentists act as private contractors to the NHS, which simply put means the Dentists buy the building and equip the Surgery, hire all the staff and pay all of the running costs including wages, materials and insurances, to provide an NHS dental service.

13

scope of service

According to NHS Choices "All the treatment that your dentist believes is necessary to achieve and maintain good oral health is available on the NHS. This means that the NHS provides any treatment you need to keep your mouth, teeth and gums healthy and free of pain.[1]". This includes if clinically necessary: dentures, crowns and bridges, orthodontistry, root canal treatment, scaling and polishing, and white fillings.

Many dentists who provide NHS services also offer additional services, such as hygienists, for payment. A dentist is allowed to refuse to provide treatment under the NHS and then offer to perform the same treatment privately.[2] However, this practice is far from clear cut.

A revised contract is under discussion in 2013 with greater emphasis on oral health and quality indicators.[3] The British Dental Association is keen to see reform, having campaigned vigorously against the "flawed, target-driven arrangements" introduced in 2006 that are currently in place