A bold challenge

Published On: 01-09-2010

The health secretary has now pronounced on the future of the National Health Service. The white paper published in July sets out the structural review that will take place over the next few years.

Andrew Lansley presented his vision of the future and once again reaffirmed the commitment to the principles of the NHS, namely: a comprehensive service for all, free at point of delivery, based on a patient's need and not their ability to pay.

Based upon this it is clear that dentistry is not core NHS. Indeed the mention of dentistry throughout the white paper is scarce: there are five in total. The key changes signalled are: a new contract will be introduced after piloting, dentistry will be commissioned by a new NHS commissioning body, GP consortia will be involved and have influence on commissioning NHS dental services, PCTs will be abolished, access and child oral health will feature heavily in the new arrangements.

Mr Lansley can be congratulated on acknowledging that the current NHS does not deliver health outcomes in many areas that are comparable with other developed countries. He rightly points out that the NHS has been dominated by wasteful bureaucracy and a 'top down' approach to the point where it has blocked innovations by staff. The same applies in dentistry.

The new NHS will have more patient choice about where they will be treated and who will treat them. Power to commission services will be placed back in the hands of GPs who will form consortia to commission local health services.

Apart from the cost savings in management the expectation is that patients will have more choice, health care workers will be happier and have more control and health outcomes will be better, with more productivity. It is a bold challenge for any politician because many of the expected results are due to happen within the lifetime of the current parliament. The same aspirations should apply to dentistry too.

There are still some important questions that have to be addressed. Some will remember GP fundholders in the 1990s. The new proposals are wider in scope but whichever system is put in place there is still a danger that the professions will be paid more by rationing healthcare provision. This is one of the fundamental flaws of the current system.

A second flaw will be to link payments to individual health outcomes rather than overall investment to health returns across a cohort. This will discourage professionals from taking on those patients with most and chronic health needs.

We need to see more details of the proposals for dentistry and hopefully the minister responsible, Earl Howe, will do what no minister has been able to do for a generation, namely to get a workable system that lives up to the aspirations put forward by the Government.


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