Heard from your local Primary Care Trust (PCT) recently? Chances are you might not have since they are winding down, along with Strategic Health Authorities (SHAs). If you didn’t already know, PCTs are being replaced by a new commissioning structure called the NHS Commissioning Board (NCB) with 27 area teams, just one less than the number of SHAs set up in 2002. These changes are being conducted as part of the restructuring of the NHS in England after the Government’s Health and Social Care Bill was passed last year, and just like building work the new architecture is being pieced together in time for April 1, 2013.
Some PCTs have worked extremely well with their clinicians, developing innovative dental pathways, however there has also been a degree of inconsistency. The NCB will carry out its work within a single operating model, providing a more consistent commissioning approach. Dental health care, for the first time, will be funded through a separate stream to general health care which will go through Clinical Commissioning Groups (CCGs) - the new GP-led bodies. Whilst some observers say that a separate funding stream will act to protect NHS dentistry, at least in the short term, others say that NHS dentistry is at risk of becoming marginalised.
Not all PCT dental commissioning managers will become fortunate enough to secure roles in area teams. General Dental Practitioners may have mixed feelings about there being less dental commissioning managers from April 1, however those breathing a sigh of relief should ponder how fewer managers will continue to performance manage GDPs. There may be greater emphasis placed upon a risk management approach and the identification of dental data outliers.
Words of wisdom
Postgraduate deanery functions will ‘lift and shift’ into the new system architecture within Local Education and Training Boards (LETBs) which are the statutory committees of Health Education England (HEE). Each LETB (otherwise referred to as a “Let it be” by dear colleagues of mine, sung in the tune of the famous Beatles song) will have input into the development of national strategies enabling workforce training to be responsive to new models of service delivery.
All dental services (primary care, secondary care and the salaried services) will be directly commissioned by the NCB, providing a real opportunity for local dental pathway re-design. But who will help to guide this exercise if there are less dental commissioning managers? The authentic clinical ‘voice’ to inform commissioning decisions will come in the form of Dental Local Professional Networks (LPNs), essentially a network of clinicians. The precise make-up of these LPNs at the time of writing has not been defined and different approaches are being tested nationally. What is clear however is that Dental LPNs are a way of grassroots clinicians influencing local and national strategy as they will become a part of the NCB’s formal structure at area team level accountable to the Chief Dental Officer. In this way, dentists will mirror GPs in providing greater clinical input into commissioning decisions than ever before. Local Professional Networks would be expected to work closely with CCGs and Health and Wellbeing Boards (HWBs) at local level. In-keeping with the vision of localism, HWBs will act to strengthen the relationship between the NHS and Local Authorities (LAs), with Public Health England (PHE) acting to support local government and the NHS.
Strength in numbers
There are cynics who feel that LPNs will serve as convenient shields for the commissioners and that clinicians will not be able to agree upon how dental budgets should best be spent. The answer may be to ensure that each LPN, which may consist of a relatively small number of clinicians, engages well with the pool of remaining clinicians within the area team footprint, who could serve as a sort of scrutiny committee. In this way all clinicians would have ‘membership’ to the LPN which would then truly facilitate the sharing of innovation and best practice amongst front-line clinicians. It is hoped that this would lead to an increase in quality, but whether this would be demonstrable is debatable in the context of the quality-access conundrum. As an LPN will be looking at improving the oral health of a resident population, non-NHS care provision will also be important to consider. A key relationship amongst all of this will be that between LDCs and the LPN. If united, LPNs could prove to be the local dental profession’s strength.
PADs and pens
The NCB, CCGs, LETBs, HEE, LPNs, HWBs, LAs and PHE. Surely we are all going to need PADs (Pocket Acronym Dictionaries) to keep up with the sheer number of acronyms being thought-up during this latest NHS restructuring. Let’s hope they survive longer than the acronyms PCT and SHA. And yes, if you wait long enough I will mention another – the CQC. Local Professional Networks could also help to culture a consistency of compliance through a shared learning of the outcome-ticking inspections.
So, back to the building work - the new NHS structure has a real opportunity of having clinical expertise embedded throughout if front-line clinicians become involved at LPN level. Otherwise, we all know what happens with weak foundations don’t we? Cracks could start to appear.
The views expressed in this article are those of the author and do not necessarily reflect the views of, and should not be attributed to, any organisation or institute that he works for.