In general dental practice it is widely accepted that single use means single use in the context of instruments and devices, such as crowns and bridges. The emphasis on decontamination and appropriate use of instruments has been a priority within dentistry across the UK. Within primary care in the NHS, there has been a particular emphasis on the ensuring that single use instruments are only used in accordance with the manufacturer’s instructions. The overall aim of these policies is to improve standards within dentistry and deliver high quality services to the public. The consequence of such policies is often increased costs to the dental providers delivering these services.
An example of such a policy is the April 2007 statement from the chief dental officer in relation to the re-use of endodontic instruments. The MHRA (Medicines and Healthcare products Regulatory Agency) also issued an updated device bulletin in December 2011 which reiterates that single use instruments should only be used in accordance with the manufacturer’s instructions. The defence bodies that work with dentists have also issued guidance to their members via their websites and various newsletters. These all seem to conclude that single use means that an instrument should be used in accordance with the manufacturer’s recommendations. If this was not enough there are also determinations from GDC hearings in 2011 and 2012 that also make reference to single use instruments and re-use of instruments. It also seems that the GDC is sending out a clear message to the profession, that single-use means exactly that.
Following the CDO’s letter in April 2007, a number of NHS PCT infection control policies have been revised to reflect the updated position on single use instruments. These local policies have often been updated to also take account the recommendations in HTM 01-05. It should therefore seem unambiguous that single use instruments and devices cannot be reprocessed for use on humans.
Quite often the financial cost of single use instruments has been hard to absorb in dental practices which have fixed income, such as NHS practices. It can be hard for these practices to modify their procedures and systems without any increase in income to cover the cost of single use technology. Advances in health technology rarely reduce short terms costs and whilst they offer benefits, it is very difficult to pass on the costs of these benefits to patients. The challenge for NHS practices is how they implement new policies whilst keeping costs down. NHS service providers have no way of transferring increased costs to patients due to the nature of fixed income. At present the provider and sometimes their associates absorb these costs, however there has to come a point where this is no longer sustainable. In the private sector, a provider can take a commercial view on how to absorb the cost of implementing new policies. However even private providers are affected as it can often be hard to increase fees on a regular basis. There comes a point where patients who are self funding are no longer willing to accept fee increases.
There have been some PCTs in England who have recognised the higher costs associated with using single use equipment in NHS practice. Those commissioners have worked with their providers to either help improve contract values or to provide supplements to cover some additional costs. In some areas these commissioners have even tried to help increase contract values for the lowest value contracts, recognising the need to invest in providers in order to raise standards.
In my view, policy makers, commissioners and providers need to continue to work together to improve quality standards across dentistry. However there also needs to be a realistic debate about the cost of policy change, if UK dentistry is to remain competitive.