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Same old, same old? For NHS contract reform yes. But…

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  Posted by: The Probe      24th January 2020

Former Chief Dental Officer, Barry Cockcroft, looks at current provisions within dentistry.

The response from Paul Bachelor to my article in the October 2019 edition really made me realise that in relation to NHS contract reform, nothing has changed much for years – but also made me think of how in almost every other area of our profession everything has changed.

Paul referred to the Bloomfield report. Published in 1992, he could quite easily have referred to the Tattersall report, published in 1964 which said almost the same thing, but did not lead to any change. I worked for over 25 years in the system that led to the production of the 1992 report and became involved in PDS piloting from 1997 as a result, but 20 years on there is no significant change in sight for the vast majority.

Dentists have always been unhappy with their contract and probably even more so now as since 2006 they do not have the control of the availability of services that they had before. It is worth remembering that it was when dentists had control of access that difficulties of access were at their worst and this led to the introduction of local commissioning.

Something else that has not changed is the willingness of those who left the NHS under the old item of service system (“because it was a treadmill”) to use unhappiness with the contractual arrangements to criticise the quality of NHS care.

Looking beyond contracts almost everything has changed; the burden of beaurocracy is massive, just as it is with other professions, dental schools now teach far more out in the community, something which they resisted to any significant degree until the new schools showed it could be done and improved the quality of the clinical experience for undergraduates.

The demography of the population is vastly different to what it was when the NHS was introduced, and techniques are now far more developed and technical. As fewer people suffer the ravages of dental caries and retain their teeth for life the periodontal needs of the population have grown, as has the need to manage tooth wear in an older population.

Possibly the greatest change is the perception of the importance of good dental health and appearance within the majority of the population, something which is really important for the future of our profession given that traditional caries related treatments will reduce.

One would hope that there will be a change in the ongoing educational opportunities for GDPs, for too long the education establishment has been fixated with specialty training but there is a desperate need for more dentists to be able to use their skills to the full in the primary care setting. In my last talk as CDO at an LDC conference, I discussed the opportunities offered by engaging in the provision of tier two services in primary care. At the time the BDA delegate who spoke against the concept was dismissive but I get the feeling that the BDA may now have realised the career opportunities this offers.

All the professions face challenges at the moment; one of my best friends is a pharmacist and community pharmacy is under huge pressure, pharmacists have seen their earnings stay flat for over 10 years, in essence, an ongoing earnings drop due to the massive overproduction of pharmacy graduates and the changes in the retail markets that used to subsidise their incomes. The latest financial settlement for pharmacists involves a five year period of no increase in earnings for the provision of traditional community pharmacy services.

The other thing which has never changed is the politicisation of the NHS at election time. How many of us really believe all the promises about increased funding which were bandied about during election time? All of these increases will be swallowed up by population changes – and trying to make the status quo in terms of service structure fit the future is futile. I suspect that everybody would like to see the politics taken out of a place of influence with the NHS, why not introduce a truly cross party political approach to the service and establish an Executive which can just get on doing the right thing for the population without having to respond to knee jerk political pressure all the time?

In a system with a constrained budget and growing demand there are always going to be difficult decisions to be made and these should be independent of political pressure.

Politicians seem to be fixated by hospitals but the system is only viable in the long term if we focus on keeping people out of hospital and invest more in primary and social care.

Parliament as a whole should agree the budget it is prepared to give the NHS on behalf of the electorate – and then stay out of it!


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