Martin Tickle1. 1. Dental Public Health and Primary Care, School of Dentistry, The University of Manchester, Manchester, UK. martin.tickle@manchester.ac.uk
Abstract
UNLABELLED: The National Health Service (NHS) in England provides a comprehensive dental service funded largely from taxation but supplemented by co-payments. OBJECTIVES: This paper provides a historical overview of NHS dental services and some personal reflections on the main challenges over the next five years. METHODS: A narrative review of the literature and some subjective observations and comments. RESULTS: In 2006 there was a radical change to NHS dental services in England; central budgets were capped and general dental practitioners. Dentists who were previously paid on a fee-for-item basis moved to a new contract that required them to hit activity targets to maintain their historical income. This contract was unpopular with dentists and has been criticized for not improving access or quality. A new dental contract has been promised based on capitation. Against this background significant issues have to be addressed including: a rapidly growing gap in between demand and resources and a need to make substantial cost savings across the whole of the NHS; a significant decline in dental need; inequalities in utilisation of dental services; and provision of treatments of doubtful effectiveness. CONCLUSION: The NHS dental healthcare system faces significant challenges and consideration needs to be given to the consequences of a focus on need rather than demand. Logically this would require a needs-based resource allocation formula and a needs-based approach to service and workforce planning. A move to a needs-led service is a political decision with associated political risks.
UNLABELLED: The National Health Service (NHS) in England provides a comprehensive dental service funded largely from taxation but supplemented by co-payments. OBJECTIVES: This paper provides a historical overview of NHS dental services and some personal reflections on the main challenges over the next five years. METHODS: A narrative review of the literature and some subjective observations and comments. RESULTS: In 2006 there was a radical change to NHS dental services in England; central budgets were capped and general dental practitioners. Dentists who were previously paid on a fee-for-item basis moved to a new contract that required them to hit activity targets to maintain their historical income. This contract was unpopular with dentists and has been criticized for not improving access or quality. A new dental contract has been promised based on capitation. Against this background significant issues have to be addressed including: a rapidly growing gap in between demand and resources and a need to make substantial cost savings across the whole of the NHS; a significant decline in dental need; inequalities in utilisation of dental services; and provision of treatments of doubtful effectiveness. CONCLUSION: The NHS dental healthcare system faces significant challenges and consideration needs to be given to the consequences of a focus on need rather than demand. Logically this would require a needs-based resource allocation formula and a needs-based approach to service and workforce planning. A move to a needs-led service is a political decision with associated political risks.