01.06.12
Dentistry and public health
Source: National Health Executive May/June 2012
Dr Susie Sanderson, executive board chair of the British Dental Association (BDA), discusses the changes coming under the NHS reforms, and the importance of local expertise in dental commissioning.
Dentistry. Like a well-known brand of wood varnish, it does what it says on the tin.
That’s true of course; a general dental practitioner’s day is filled with the treatment and prevention of dental disease. But it’s only part of the story; the care dentists provide impacts on a much wider range of health outcomes than just dental ones.
How well dentistry’s wider contribution is understood – by patients, the media, commissioners and even non-dental clinicians – is, though, often not clear. The fact that a suggestion that dentists might ask patients about their alcohol intake could even be considered news – never mind generate the headlines it did in April – reminds us that the public is not as aware as we might assume about the factors that impact on oral health and the work dentists routinely do to address them.
And those responsible for commissioning dental care – in recent years in England commissioning staff at primary care trusts – cannot universally boast an appreciation either of the contribution that dentists make. Some commissioners clearly know their onions, and are equally interested and enthusiastic to explore dental contributions to public health, but that’s not always the case.
The passing of the Health and Social Care Bill earlier this year signalled what looks likely to be a significant shake-up in the position of dentistry in the health family. Dentistry will be commissioned by a National Commissioning Board (NCB). The British Dental Association sees this as a positive step that will mean practitioners are no longer subject to the variation of commissioning quality that they have experienced as a result of being commissioned by staff at the 150- plus PCTs. But this move will, of course, risk divorcing dentistry further from our medical counterparts, as general medical practice becomes the responsibility of local commissioning groups.
That risk, we believe, can and must be mitigated by ensuring that appropriate local expertise informs decisions about dental commissioning and that Local Professional Networks properly link clinicians’ ideas and efforts to produce a coordinated, complementary approach to tackling local health issues.
A vital issue, as pointed out by the BDA consistently during the passage of the Bill, will be the place of those with responsibility for oversight and planning of care on a mass scale, the Consultants in Dental Public Health (CDPHs). They are, as has been the case for some years now, too few in number, but the CDPHs we do have play a pivotal role in ensuring that the care dentists provide and the public health initiatives in which dentists and others play key roles are effectively planned and executed. Looking upwards and sideways, they are also a key linkage in connecting dentistry into the health family at a strategic level. Their place and function in the new arrangements will be vital; they are the link without which the chain would not work.
Management of change will, of course, be a significant challenge. Dentists know all too well how potentially disruptive a change of commissioning arrangements can be, with many having suffered at the hands of PCT reorganisation-linked chaos around the introduction of the current dental contract in 2006.
Government will need to watch carefully to ensure that the simultaneous transfer of commissioning responsibilities to the NCB and the establishment of the other agencies and linkages that will make national commissioning work locally is managed properly if a similar period of uncertainty is to be avoided.
That’s particularly the case because, in a strange twist of fate, dentistry will once again be experiencing parallel changes to both its contractual and commissioning arrangements. The development of a new contract is still in its relatively early stages, with approximately 70 practices trialling three variations of a new arrangement that attempts to restore a formal element of capitation to general dental practice. The aim of the new arrangements is to move towards a more preventive approach to care for which the dental profession has lobbied for so long. Dentists are, despite the ignorance of some, already engaged in and committed to, preventive activity and contribute particularly to two of the biggest issues confronting public health in this country; alcohol and tobacco use.
It is hoped that new contractual arrangements will allow practitioners to enhance the preventive work they are already trying to do by providing the time necessary to undertake more in-depth oral health education with patients.
Radical change is about to hit dentistry. Dealing with it means embracing the positive things that will fall out of it, and making sure we are careful to guard against new threats; including that of the change being poorly managed. Dentists’ relationships with other members of the health family will be vital. They must resist the temptation to look myopically towards the National Commissioning Board, and other health professionals must guard against mentally sidelining dentistry.
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