New ways forward for dentistry

Great changes are happening to the dental profession, and the outcomes have, until now, been impossible to predict. Dental staff shortages a...

Great changes are happening to the dental profession, and the outcomes have, until now, been impossible to predict. Dental staff shortages are worrying the Government, as is the lack of NHS dental treatment across the UK. The new NHS contract has led to mass uncertainty among thousands of dentists, who face difficult negotiations with inexperienced officials.

With the dental market in this state of uncertainy, a study has arrived at some surprising conclusions. Denplan recently commissioned the Office for Public Management to carry out a bold simulation of a complete dental market, with representatives from every relevant body playing their own roles. Dental practitioners, Primary Care Trusts (PCTs), Strategic Health Authorities, the Department of Health, regulatory bodies and patient representatives all attended, to explore the future of dentistry. The rules were simple: each participant simply needed to behave as they would normally, in a range of simulated situations. In other words, the outcomes depended on the negotiating and bargaining power of each player, in realistic scenarios set in 2005/6 and in 2008/9.

The report, \Dentistry: New Worlds, New Ways\, contains significant findings. Most importantly, the study indicates that England could be on the brink of a ‘New World’ in dentistry. Rather than a ‘roll-forward future’, with provision of similar services at different quantities, the future of dentistry requires totally new ways of thinking, funding, organising and working.

Modernisation will probably be stalled in the coming year, adds the study, when the Primary Care Trusts begin to take on their new managerial role. ‘Most of their energy and expertise’, the report notes, ‘will be taken up with negotiating new contracts with dentists: modernisation at the same time for many PCTs is a tall order.’ The author of the report, Sarah Harvey of the Office of Public Management, expanded: ‘It was clear from the outset that PCTs and dentists talk different languages, and inhabit different worlds. A major task will be to bring a common understanding in the limited time available to them.’

Further challenges include the problem of imperfect information. Patients were unsure of what NHS dentistry embraces or excludes, or indeed of its cost. Both nationally and locally there is only a high-level grasp of the dynamics of demand for and supply of dental services. According to the report, ‘this needs more rigorous analysis if dental services are to be planned effectively.’ The market cannot operate efficiently while such uncertainty exists. Roger Matthews, Denplan’s Chief Dental Officer, commented: ‘Dentists who want to get some understanding of how PCTs think ahead of the contract negotiations should read this report; and PCTs looking to gain some insight into dentistry will also find much to ponder.’

The report is useful for public planners, too, for it highlights several possible models for both the provision and funding of future dentistry. Lester Ellman of the BDA sums it up: ‘There are no second chances on this. Dentists and PCTs alike will need to think openly and imaginatively about their futures: the most successful partnerships will be those that adapt most effectively to the new dental world.’

New patient charges confirmed

Corroborating the story first leaked in Dentistry magazine’s 16 June issue, the Government has announced a proposed system for new patient...

Corroborating the story first leaked in Dentistry magazine’s 16 June issue, the Government has announced a proposed system for new patient charges.

In the form of a report by Harry Cayton, the new charges will be a banded system as extensively leaked. The patient will pay a single charge appropriate to the highest band in which their treatment occurs. The banding is:

• Band one: covering clinical examination, radiographs, scaling and polishing, preventative dental work, such as oral health advice (£15)

• Band two: covering simple treatment, for example fillings, including root canal therapy, extractions, surgical procedures and denture additions (£41)

• Band three: covering complex treatment, which includes a laboratory element, such as bridgework, crowns, and dentures (£183)

• Band four: urgent treatment covering examination, radiographs, dressings, recementing crowns, up to two extractions, one filling (£15).

The charges are not cumulative so an exam, scaling and two fillings would attract the band two charge and an exam scaling root treatment and a crown the band three charge. Dentists will still be responsible for collecting the charges, but the Department has accepted in principle Cayton’s recommendation that bad debts should be written off by the PCT if a ‘vigorous’ attempt has been made to recover them. This will be contained in the forthcoming regulations.

The objective for the Government is to collect a similar amount as under the existing regime, but the amounts originally suggested by Cayton were for £11/£31/£130-140 for each band respectively. The far higher amounts in the consultation document must reflect and compensate for the lower incidence of these courses of treatment under PDS. The new charges may mean that dentists can offer private treatment at below the NHS charge, in the name of ‘patient choice’. Many dentists may regard these charges as an incentive to increase the proportion of private work in their practices. It would be necessary to make clear to patients that their treatment was private, not carried out under the NHS.

The proposed new charges will go out for public consultation over the next three months before being laid before Parliament as regulations to come into force from 1 April 2006.

It was also confirmed that this date will be when the new system starts with new GDS contracts coming into force and existing PDS contracts becoming permanent.

Negotiations over new contracts will take place from September this year and during this time no more pilot PDS contracts will be approved, unless there are exceptional circumstances. In the near future draft regulations will be laid before the House of Commons, but prior to that there will be consultation with the BDA and other interested parties.

The Public Accounts Committee in its report on 14 July expressed its concern on whether these new charges will collect sufficient sums: ‘Dentists will no longer have a financial incentive to try and collect debts from patients who fail to pay the correct NHS charges for the treatments they receive because, under the new system, dentists’ income is guaranteed for three years and is not dependent on the level of charge income.’

The new charges will also determine how the new arrangements will be monitored; the so-called currency of the contract. It is likely that the concept of weighted courses of treatment is to be called Units of Dental Activity. If dentists are contracted to provide a certain number of courses of treatment in each band they will have to do this or risk a reduction in their contract value in future years. The Minister also announced that draft regulations would shortly be laid before Parliament. The regulations will cover the new GDS contracts, making PDS pilots into permanent contracts and performers regulations. Before laying the regulations before Parliament, they will be discussing their content with ‘the profession, NHS management and other key stakeholders - so that effective, workable local contracts can be agreed in order to deliver our commitment to modernise the general dental services (GDS) contract by April 2006’.

The Department announced that only applications for PDS pilots received before 7 July would be processed, in preparation for bringing the rest of the profession into the new arrangements. PCTs have been briefed on these changes (and patients’ charges seewww.primarycarecontracting.nhs.uk).

Career crossroads

You’ve completed your VT year, but what now? Julie Ferry outlines your options.

When vocational training (VT) comes to an end, it’s time to weigh up your choices. Having survived the nerves and rigours of life after dental school there is another decision to make before you can continue - what’s next?

Well, there is plenty. Much to look forward to in a profession that is growing by the day and throws up more challenges and opportunities than the average Joe Bloggs might think. There are a whole array of different routes you can use to get to your chosen destination and if you haven’t yet decided where you are going, that’s ok too, because dentistry enables people to move around frequently and you can always change your direction at a later date.

Many VT days are devoted to ensuring that VDPs have all the information they need to move forward. However, for those of you who are still a little confused, here are just some of your career options and how to find out more.

Choosing to be an associate is the most popular route for VDPs. Whether you have been offered a position at your VT practice or you have decided to take a job elsewhere, it is a good way of honing your skills a little more, earning some money and having the sense of security that moving between jobs regularly can’t bring.

People choose to become associates for all sorts of reasons and not all of them are professional. Many of them are personal and linked to quality of life and work/life balance. With an associate’s position, you generally have a large say in your working hours, how many patients you see and what time off you can take, because essentially you are self-employed.

The financial rewards can also be tempting as most people will see a substantial increase in their salary over the first 12 months, which can help to ease any student debt still hanging around. Of course many people like the rhythm of practice life, enjoy getting to know their regular patients and may want to eventually become practice owners. Owning your own practice is a big step up from an associate, but learning the ropes from a helpful principal may be just what you need to get started.

If you want to become a specialist in any discipline you will have to follow the correct training pathway. That usually means a minimum of two years of structured training, gaining experience in several branches of dentistry. A good way of gaining this experience is to be accepted on to a

General Professional Training (GPT) scheme or working as a senior house officer at a hospital.

You are also required to complete your Diploma of Membership of the Faculty of Dental Surgery (MFDS). The MFDS is a qualification designed for those wishing to qualify for entry to specialist training. Once you successfully complete the MFDS you can seek entry onto an approved specialist training programme. Some equivalent qualifications to the MFDS will also be acceptable when applying.

Specialist training will last a minimum of three or five years depending upon the speciality. For example, special rules exist for people wishing to specialise in orthodontic or paediatric dentistry. For these disciplines you are required to complete an additional minimum of two years training on top of the basic requirement of three years.

All specialist trainees are issued with a National Training Number (NTN) by their postgraduate dean and are assessed throughout their training to ensure that the necessary support is being given and progress is being made. Once specialist training has been completed you will be awarded a Certificate of Completion of Specialist Training (CCST). This means that you can gain entry to the specialist list in your discipline and that you can call yourself a specialist.

Post-VT, you can also apply for a hospital job and you will usually be applying for a senior house officer position. You will have to choose which discipline you want to specialise in and also find out whether this involves you doing any on-call work.

Hospital jobs can be beneficial because they will give you further experience in a particular area. This may lead to you being more confident with certain procedures and, if you decide to go into practice, comfortable enough to carry these out in a practice setting rather than referring patients to your local hospital. These positions can also give you a taster of what it is like to specialise. If you are unsure if this is what you want to do, a year or two in a hospital setting may help you make up your mind.

Many people feel that after five years of studying followed by a challenging year of VT, they want to take the opportunity to go away and work abroad. There is no doubt that this is a good time and may even help you make decisions both professional and personal that you may have otherwise put off. Preparation is the key to being able to make the most of your time away.

It is important that you take a lot of time to research the country that you are going to be living in, its visa

requirements and the job market. You need to ensure that where you are going offers the right opportunities for you and that it fits in with your plans.

For example, some countries have a surplus of positions for dentists in rural areas but have very little available in the cities. Working abroad is a fantastic way of broadening your experience and skills while seeing some of the world. It also gives you the time and space to decide what the next step on your career ladder might be.