Nhs Dentistry Review Essay Example

Nhs Dentistry Review Essay Example Nhs Dentistry Review Paper Nhs Dentistry Review Paper The purpose of this analysis is to identify the key findings in â€Å"NHS dental services in England – An independent review led by Professor Jimmy Steele†. The reasons for the commission of the report will be explained and the main findings will be compared with other sources. In 2009 Professor Jimmy Steele – practicing Dental consultant, researcher and the current head of the Dental institute at Newcastle University – led a review into National Health Service (NHS) Dental services in England. The aim of the review is to provide advice to the Government on how NHS dentistry could â€Å"become more accessible and efficient, be delivered to a higher quality and be more preventively focused†(1). Professor Steele and his review team did this by determining the problems in NHS dentistry, reviewing the core principles of the NHS and how they apply to dentistry and finally once there is a clear picture of NHS dentistry and its pros and cons from multiple viewpoints was obtained the review team were able to specify and recommend solutions as well as identify who would be responsible for delivering the changes. The research team began outlining the history of dentistry in the NHS. Prior to the birth of the National Health Service, in 1948, oral health in England was very poor and extraction was favored over treatment (2). Oral health is defined as a standard of health related to the oral and related tissues that allow the individual to eat, speak and socialize without discomfort or embarrassment (3). Patient charges were brought in after three years. Although oral health improved, one area seemed to stagnate and that was that the system focused on treatment rather than prevention. Patients were not taking â€Å"responsibility for their oral health†(4) or being advised to do so. The cited improvement in oral health in the UK is backed up by studies referenced in Dental Public Health – A Primer by Patel Patel. The percentage of edentulous (lacking teeth) adults declined from approximately 38% in 1968 to approximately 12% in 1998 (Kelly et al. , 2000; Gray et al. , 1970)(5). The 90’s saw an increase in private practice as Dentists saw a 7% cut in fees paid by the Government (6). At the time of the report, Dentists were able to decide how much NHS care vs. private care they offered, if they offered NHS care at all. Dentists were also able to pick and choose which treatments they offered via the NHS. As is with the whole of the NHS, Dental services can be controversial. There is diverse opinion in terms of what the public can expect from NHS dentistry and how much they should pay for it. Aside from prescription contribution most of the rest of the NHS is a free at the point of access service and there are many who feel that dental services should be the same. Another rising concern since the 90’s is access, as previously stated many dentists are turning towards private practice and away from the NHS. Access is deals with ease of availability and accessibility of dental services when required (7). Which? Consumer research group stated that 68% of those surveyed, during a parallel study, 90% of those were able to get an NHS dental appointment, however those who not able to were affected severely (8). Through quotes from the public and data from an external survey, the review suggests that the main concerns from the public are access, cost, transparency and quality dentist/patient relationship. Many dentists in the UK, as in many parts of the world, have a dual role as clinician and businessperson. The dentist has to balance good clinical decision-making and prescribing the best care plan with managing their business and meeting costs (9). Dentists are also often faced with what they feel is government bureaucracy and substandard commissioning of services. At the time of the review Dentists were re-numerated for NHS work through UDA’s or Unit of Dental Activity. Each treatment is assigned a value in UDA’s depending on the complexity of the treatment and the dentist is paid a varied amount per UDA depending their contract. The contract comes with a target number of UDA’s to be delivered in a 12-month period. A consequence of this system is that many dentists felt they were operating in a manner contrary to the reasons they entered dentistry in the first place. Dentists had become target driven, looking to meet their UDA target in the most efficient way possible in parallel with optimum patient care, two objectives that some felt were the antithesis of each other. For example same dentist can treat a patient for many years, but when that patient requires a more complex treatment that is not cost effective to the dentist, the patient can be turned away. The patient is then left to find another dentist is the area that will provide the necessary treatment via the NHS, with no clear system on how to do this and a presumably worsening discomfort or pain. Although care is taken to examine the views, needs and motivations for patients, dentists and the Primary Care Trusts (PCT) and Department of Health (DOH), this analysis will focus on the implications for the public and dentists. By highlighting the responsibilities to each other of the three groups, the review team were able to make recommendations on potential changes to the system. The findings and recommendations of this review are grouped according to the three invested and interested parties. Much of the recommendations in regards to what the patient should get centers around information. Multi-platform public information campaigns that support and educate patients to take responsibility for their own oral health and inclusion of oral health benefits in overall recommendations that include reducing alcohol intake and stopping smoking (10). The review also recommends national and local campaigns on â€Å"how to find a dentist and what to expect† when the patient gets there. Access itself features heavily in the recommendations, including emergency care, continuing care and complex care. The Which? report goes further in its recommendations to say that Dentists not taking on NHS patients should have a duty to direct patients to the PCT (11) for further direction to an alternative local NHS dentist. Patient charges is something that was always going to feature, according to the review patient charges underwent a severe simplification in 2006 from close to 400 fees to 3 cost bands for different treatments (12). The suggestion is that the simplification was too extreme and that any future review of the charging scheme should increase the cost bands to 10 and that they should align with the cost of the provision of the treatments and finally that patients should be incentivized to take good care of their oral health. Recommendations for changes in the contract between dentists and PCT’s look to shift dentists to be re-numerated based on activity, quality and continued care as opposed to just activity. There is also a clear suggestion that care providers, the clinic owners, should ultimately be responsible for quality of care as well as for quality of the treatment environment. The review is also careful to advise that any changes in the contract should be piloted before full rollout, as this was identified as lacking in previous changes. The public can only benefit from further education on and a greater investment in their own public health. Any education campaigns should be targeted heavily on the young in order to change the mindset of a generation with information being provided via appropriate media to affect all current and future dental patients. Patients would also benefit from a demystifying of the dental profession with more open communication from the dentists about the treatment they receive. A change in the dental contracts as recommended in the review should allow dentists to begin seeing their patients as individuals again and allow them to spend more time with their patients and ultimately bring more dentist back to the NHS, which in turn would improve access. A more engaged patient as a result of education would also let the dentist feel confident in prescribing long-term care plans rather than acute treatment. In conclusion NHS dentistry must balance the delivery of services to the public as and when they requires or desire it with a suitable incentive programme that drives dentists to deliver against these needs all whilst maintaining a reasonable cost to the patient and the PCT’s. The sources cited in this analysis agree that prevention should be prioritized over treatment, however this requires patient participation and engagement, which can be achieved with public information campaigns and more open dentist/patient relationships. NHS dentistry in England is a complex machine that requires slow and steady change with continued feedback from the public and dental professionals in order to continue to evolve and maintain high standards of care and become preventively focused. References 1, 2, 4, 6, 9, 10 ,12. . 2013. . [ONLINE] Available at: blackcountry. nhs. uk/wp-content/uploads/2012/04/The-Steel-Review. pdf. [Accessed 08 May 2013]. 8, 11. . 2013. . [ONLINE] Available at: which. co. uk/documents/pdf/independent-review-of-nhs-dentistry-which-response-178905. pdf. [Accessed 14 May 2013]. 3. Meera Patel Nakul Patel, 2006. Dental Public Health. Edition. Radcliffe Publishing Ltd. p5 5. Patel Patel, p14 7. Patel Patel, p46