The ongoing daily debate about funding in the NHS seems to be unstoppable. You may wonder to what extent NHS dentistry is affected by this apparent funding crisis. It may be that because we have been operating under such extreme austerity measures for such a long time that it’s hard to remember that time when NHS dentistry was in a better place. The recent DDRB uplift highlights the challenge we face of rising cost pressures but a negligible increase in NHS contract values.
There was a time in the NHS when dental providers could access capital funding to support the development of services. However, the fragmentation of the NHS has created an ever expanding divide. In the last financial year capital funding allocations were made to CCGs to distribute to their member GP practices which meant dental providers
were excluded. Similarly dental providers were not able to access the Prime Minister’s Challenge Fund as there was an arbitrary condition that bids had to be hosted by a GP provider.
In some areas secondary care dental services are under immense pressure with some commissioners reporting overspends against anticipated expenditure. There is a growing misconception that it’ll somehow be cheaper to deliver these services outside of a secondary care setting. NHS England has been developing commissioning guides for dental services which may help commissioners with development and design of services; however what remains unclear is how these pathways will be funded. The recent health select committee heard evidence describing the increase in referrals for hospital based children’s dentistry. The reasons for this increase appear to be multi factorial, however if we use overall NHS performance as an indicator it’s possible that demand will continue to rise. If alternatives to secondary care based services are to become a reality then they will need to be funded. This resourcing will be more than simply taking the funding out of hospital contracts and creating services in a community setting.
The long term view would always be that population health improves and the burden of disease gradually reduces. In England, significant cuts are being made to dental public health services; it seems unlikely that population oral health will improve in the near future if we no longer have the specialist expertise to design or implement the most appropriate solutions.
There have been lots of areas in England where NHS commissioners have undertaken orthodontic needs assessments recently, some of these are now in the public domain. What has been interesting is to read the different approaches to assessing orthodontic need and the differing interpretation of existing contract values. The
recommendations relating to average values for units of orthodontic activity seem to be less about needs and more
about releasing resources currently tied up in contracts. It’s unknown whether any savings from future re-procurement will be reinvested into NHS dentistry or whether this will simply reduce overall NHS expenditure.
At a practice level there is the added pressure of greater delivery for the same resource. At the time the 2006 contract was introduced, Department of Health representatives seemed to sing this mantra of ‘swings and roundabouts’. They seemed to be inferring that general dental practice operated in some sort of risk pool of both patients with low needs and those with high needs. It’s possible that in 2007 the risk pool may have been mixed but soon after NICE recall guidance was implemented that risk pool became ever more concentrated and the cost of
delivery started to creep up.
In my view, NHS dentistry is even more exposed to the funding crisis in the NHS than the rest of primary care. It seems unlikely that the solution will be found by continuing to deliver more for less or commissioning at ever reducing contract values. Let’s hope that a future government recognises the need to invest!