Kevin Lewis column
 

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Kevin Lewis column

 

Kevin Lewis column

Kevin Lewis ponders the inconsistencies in the relationships between certain PCTs and the private sector.

We appear to be in something approaching a state of confusion regarding the ‘fit’ between the private sector and the NHS. Mention private dentistry in some NHS circles and you still encounter a sense of recoil, or get a whiff of something ever-so-slightly unpleasant.

But the reality is that, in most cases, private dentistry is not competing with the NHS, but actually underwriting it. Successful NHS practices that have needed to grow during the last 12 months have struggled to do so within the NHS, because nervous PCTs have been locking away any spare cash in war chests to provide against possible shortfalls in patient charge revenue. In any event, growth in the NHS comes with more strings, more patients and less time. Growth in the private sector means exactly the reverse, with the practitioner (rather than the PCT/LHB) in control.

The additional income and profitability generated by an incremental shift to the private sector is money that helps to buy equipment and materials, improve and maintain infrastructure, and retain and reward the staff of an otherwise NHS practice. The derisory pay awards recently announced for the public sector – including less than 2% for nurses, at a time when medical GPs have done exceptionally well – have come as a sharp reminder of the vulnerability and inequities of life in a publicly controlled environment. 2% of not very much is not very much. Patricia Hewitt must be relieved that she is only the Secretary of State for Health, and not someone who is actually trying to earn a crust from the lower reaches of healthcare provision. If she is invited to speak to the Nurses’ Conference again this year, can we all buy tickets?

Have you noticed the latest output of the spin machine, incidentally? As the end of the financial year approaches, one would think that hospital wards and operating theatres around the country would be looking forward to an end-of-term party. If they were still open, they probably would be. Sadly, the dust sheets will remain in place until next year’s budget comes to the rescue in a few weeks’ time. In the meantime, ailing PCTs are no longer to be described as ‘facing deficits’ or ‘in deficit’. They are now to be described as ‘overspending’ – which points the finger of blame in an altogether different direction. It also gives a whole new meaning to ‘speech therapy’, don’t you think?

Returning to the subject of private dentistry – in case you thought I had forgotten – it seems to me that some PCTs are long overdue for a crash course on the commercial realities of general dental practice.

Without the contribution made by private dentistry, some practices could not continue to offer NHS treatment at all. And as the referral/secondary care backlog grows, it is the private sector that has the specialists, and the capacity. But having the capacity is not the same thing as having the will and the desire, because private dentistry is not about how cheaply you can do something, but about how well you can do it.

Private dentistry is (or should be) concerned with delivering what ‘Options for Change’ talked a lot about – patient experience, information and choice. I don’t actually believe that private dentistry is synonymous with consistently higher standards and the pursuit of excellence – as some would have you believe. It is often simply about giving the patient what they want, when they want it, in the way they want it – which may not be the same thing at all.

And nor is private dentistry about convincing a third party (such as a PCT) that they have received value for money and leaving them happy with the outcome. It is about the patient (and also the dental team) being happy with the outcome. If I remember the song correctly, it takes two to tango – not three.

In the same week recently, two dentists were challenged regarding private dentistry. One for promoting it too enthusiastically, and the other for not offering it at all. And yes, two different PCTs were involved, in different parts of the country. And therein lies the problem.

In some PCTs there is a top down suspicion of, and resistance to, all things private. In others, they are delighted if dentists in one, over-provided part of their patch go private because it frees up money with which they can commission NHS services in another part of their patch where the need if greater. There are forces at work here that have nothing to do with UDAs – yes, honestly!

We have become accustomed to the NHS using market principles like the private sector, talking up quality issues like the private sector and empowering the patient like the private sector. April 2006 has even introduced us to the novel concept of some NHS patients paying more than they would for the same treatment in the private sector. All we need now is for the NHS to start paying like the private sector, and rewarding effort and performance like the private sector, and it is game on.

Right now it is the wagging finger of the PCT, the offstage semaphore of the linesman’s flag, in the shape of the BSA’s exception reports, and the endless shrill notes of the referee’s whistle that is interrupting play. At the same time it is reminding everyone that it might at least be a little more peaceful in the private sector. Especially at this time of year.

 Posted on : Tue 20th - Mar - 2007

 

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