Health Minister stands by the new contract
 

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Health Minister stands by the new contract

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Health Minister stands by the new contract

 

Health Minister stands by the new contract

In an exclusive interview with Dentistry Magazine, Rosie Winterton answers the questions dentists have been desperate to ask.

Penny Palmer reports:

NHS dentistry offers high quality care, supervised neglect will not be a problem, and dentists may provide a mixed package of NHS and private care said the Health Minister Rosie Winterton.

Speaking exclusively to Dentistry magazine Rosie Winterton said: ‘In terms of public health, dentistry is a great success story – with the healthiest teeth of 12 year-olds in Europe and adults, with no teeth down from 38% in 1968 to 12% in 1998.

For dentists concerned with list size ownership, Rosie said that the Government has made it clear that it wants dentists to continue to care for their existing patient base, and that nothing should cut across this. ‘Goodwill remains with the practice,’ she said.

Child-only lists

The ongoing debate on child only lists is straight forward, continued the minister. ‘The regulations are absolutely clear that, subject to the local PCT’s agreement, a practice may agree a contract for certain groups, such as children.’ It is up to the PCT locally how it wishes to contract with its local dentists, added Rosie.

When asked why dentists should bother doing more than the minimum work if they are to receive the same UDAs, she said: ‘Dentists are still required to provide all the treatment that is clinically necessary. The new system gives more discretion to dentists to use their clinical judgement to determine appropriate care for patients.’ She added that there will not be a set list of items of service, or a system of prior approval. ‘We do not believe that supervised neglect will be a problem. These changes are based on the premise that dentists are healthcare professionals and will carry out the right care in the appropriate clinical situation in their patients’ best interests.’

Besides this, contract values are based on historical activity, added Rosie, which includes a range of treatments. ‘Assuming clinical needs don’t alter, the Government will expect the same broad range of treatments to be provided.’

Mixed treatments

Mixed treatments have also caused confusion with dentists. On this, Rosie said:

'The situation on mixing is straightforward. We have not changed it and dentists may provide a mixed package of NHS and private care if that is what their patient wants.

‘On a single tooth you can now mix a course of treatments, where previously you could not. With white fillings, dentists will provide the most appropriate treatment and materials.’

With the ambiguous distinction between cosmetic, social and clinical needs, Rosie comes clean. She said: ‘The distinction is not vague. A definition of a course of treatment is included in the regulations: “an examination of a patient, an assessment of their oral health, and the planning of any treatment is to be provided to that patient as a result of that assessment”’.

Independence concerns

For dentists worried about their independence, Rosie says: ‘You have a contractual requirement to provide a level of services over a year. Access to private financial accounts is not
included in the contract.’

And if dentists don’t achieve the right amount of UDAs, they will not be penalised. Said Rosie: ‘It’s up to the PCT and dentists to ensure a sensible contract value is agreed. The mid-year contract review may well be an opportunity for dentists and PCTs to discuss activity levels.’

Shortfalls in patient payments was another issue raised. Rosie commented: ‘As with the current arrangements, dentists are responsible for collecting NHS patient charges. We would expect dentists to use the typical routes to chase up bad debt as now, via the small claims court.
‘But the new GDS and PDS contracts give PCTs new powers of assistance, including financial support, to assist dentists who cannot recover the original patient charge.’
Recommendation by a dental reference officer would be on clinical matters, continued Rosie, and any treatment delivered as a result of such a recommendation would be included in the level of service agreed with and funded by the PCT.

Meanwhile, the Government has made amendments to the charges regulations to reduce the cost of replacement appliances to 30% of the band three charge. Also, ‘the costs of the original appliance has reduced in half from £384 to £189, and repairs to appliances remain free of charge.’

Funding

To appease issues raised with funding, Rosie said: ‘Funds for dentistry are ring fenced, so there will be a clean balance sheet for dentistry – 24% or £325m larger than in 2003/04.’

Similarly, on concerns that PCTS may withhold funding after 1 April 2006, dentists can relax. ‘Dentists are responsible for agreeing contracts and once made, the PCT is responsible for payment, unless the dentist defaults on the original agreement.

When asked why PCT’s ‘don’t share the DoH’s enthusiasm with the new contract’, and ‘could it be that they are being asked to do a very difficult job without the necessary funding?’ Rosie was in denial: ‘PCTs are extremely enthusiastic about the new contract, which allows local commissioning for dental services. They have received their allocations for dentistry as we promised.’

And in response to dentists saying the contract is vague, with no thought to quality of treatment, Rosie was reticent: ‘It’s not vague at all, it offers dentists a better way of working. We know that dentists in PDS contracts already have more time to spend with patients – this advantage will be available to all patients when the new contracts are introduced next April.

Happy dentists?

Finally, in response to dentists asking for evidence that
dentists are happy with the contract, Rosie remains
adament. ‘In the meetings I have attended, and those addressed by the Acting CDO, Barry Cockcroft, many dentists have said they will sign up to the new contracts.
‘Dentists recognise there is a good deal on offer – reduced workload, no reduction in income, continued access to the NHS pensions scheme, an end to the treadmill and enhanced clinical discretion.

 Posted on : Wed 11th - Jan - 2006

 

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