PCTs: The state of play for dentistry
 

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PCTs: The state of play for dentistry

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PCTs: The state of play for dentistry

 

PCTs: The state of play for dentistry

It's been a hard road for everyone involved in NHS dentistry since the reforms of 2006.
The move to local commissioning, so championed by chief dental officer Barry Cockcroft, has been a fraught one.

The distinctly mixed response from the profession has mirrored the mixed results to come from putting more control into the hands of the Primary Care Trusts (PCTs).

The negative aspects of these results are well documented. Clawbacks, unsustainable UDA values, intractable commissioners; the list of complaints goes on – and, if you haven't experienced these things directly, then you'll have heard of someone who has.

"They aren't clinicians. Some don't even have a dental clinical lead to help them; and with the best will in the world, working in the dark is never going to lead to
positive results"

The ground-breaking legal battle fought by the profession's unofficial champion, Eddie Crouch, will be a sadly familiar tale to almost everyone reading this, but even his example was just one of many across the country. Bringing PCTs into the fold was intended to improve access, dispense with the hated ‘treadmill', and allow health officials to target care where it was most needed.

Instead, it has lead to dentists leaving the NHS, a decrease in complex treatments, and widespread dissatisfaction among the profession.

The results, it is safe to say, have been far from perfect.

The whole story
But how fair is the public criticism? In customer service circles, there is an oft-quoted statistic that says when somebody has a bad experience, they tell on average, 10 people about it – but when it's a good experience, it's more like two.

So is the reaction nothing more than a vocal minority? The response of the DoH, in commissioning Professor Steele's high-profile look into NHS dentistry, suggests not.

The idea that there are problems with the new contract is unlikely to raise an argument from anyone (except perhaps the CDO himself). Professor Steele, while supporting this, took a more partisan approach. His message was clear; that while there are problems, the new contract is not as irretrievably flawed as many believe.

Professor Jimmy Steele

He highlighted two of the fundamental issues that shape today's geography – a huge variance in the quality of commissioning, and the importance of the relationship between dentists and their PCTs.

These issues are not simple ones. PCT commissioners are often people with little experience in commissioning treatment, and even less in the field of dentistry.

They aren't clinicians. Some don't even have a dental clinical lead to help them; and with the best will in the world, working in the dark is never going to lead to positive results.

That's not to say that positive results haven't happened – but it's also true that when they do, the PCTs response to its newest rising star is to move them onwards and upwards to ‘better things'. Not having consistency equals a lack of stability, and the effects of this are all too familiar.
Professor Jimmy Steele made a good point when he said: ‘In 2006, many of the PCTs didn't know what they were letting themselves in for.'

Making it work

The effect on the profession has been profound. At the LDC Conference in June, the audience overwhelmingly supported the suggestion that acting professionally – something it defined as ‘making a million tiny decisions daily and taking personal responsibility for them' – has been more difficult since 2006.

Just over half the conference identified difficulties in the relationship between them and their PCT.
So integral is this relationship to the whole process of offering NHS dentistry that it cropped up time and again on the schedule at the BDA conference in the summer. It completely dominated the LDC conference.

The BDA itself has come round to the idea and is working with Professor Chris Drinkwater on a resource for PCTs. There is a slowly growing recognition that perhaps PCTs can't do it all on their own.

The most infuriating aspect is that it's not all bad – there are some shining examples out there. Take Salford, which has lent weight to Barry Cockcroft's insistence that the contract is fit for purpose.

A triumph of innovative commissioning, its ‘traffic light' system goes beyond the UDA by setting up a framework for monitoring the improvement in patients' oral health.

But PCTs don't have to reinvent the wheel to achieve things – look at the efforts being made in both Hounslow and Kensington & Chelsea, to bring patients back into the NHS fold, for example.
For all that, the UDA is an imperfect measure, its implementation doesn't have to be as painful as it has been in some areas. Communication is the key to any relationship, and the one between dentists and PCTs is no different.

There are successes. That the contract can work in its present form when supported by a forward-thinking commissioner shows just how crucial the role of the PCT is for today's NHS dentists.

That the UDA can work when implemented by commissioners with an understanding of dentistry is as much a credit to these people as it is to the contract itself. These exceptions, regardless of whether or not they prove the rule, suggest that there may still be hope yet. 

Stand up
Over the coming months, Dentistry magazine and www.dentistry.co.uk will be pulling the veil aside on the state of the nation's PCTs, talking to the main players to build up a picture of the way things really are.

But this will only tell us so much; we want to hear what you think. Are you part of a satisfied, but silent, majority? If you've had a good experience with your PCT, then don't just tell a few people; let us know. And if things haven't been so good, speak out – it's time your voice was heard.  

 


We want to build up an accurate picture of how PCTs are performing – and we need your help to do it.  The profession is at yet another crossroads, on the brink of more changes that will affect the lives of thousands of people, dentists and patients alike.
How far the Department of Health will take Professor Steele's recommend-ations remains to be seen, but only with a clear picture of the way things are now can they move forward effectively. We need your thoughts to help paint this picture.

Simply click here to have your say in our online survey.

 



 Posted on : Wed 30th - Sep - 2009

 

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