Nat King Cole's recording of The Christmas Song begins with the phrase 'Chestnuts roasting on an open fire.' So to celebrate the season this month I bring you an old chestnut in dentistry: the core service.
Dentists have been moaning about National Health Service dentistry for ever it seems. Perhaps there was a 'golden age' of in the 1970s or 1980s, but I doubt it. The dislike of the present contract is profound, but even at times when we were happy, our paymasters, the Government, were not.
When we all gather round and discuss what is wrong over a few pints (in the old days), or in more modern times, alone with our PC, some bright spark always says: 'OK what would you do?' To which the standard answer is, and seemingly has always been: a core service.
It is the philosopher's stone that will turn the base metal of UDAs into the gold of a proper way of paying dentists. So what is meant by the phrase and would it work? There are, however, not one, but two ways of looking at this concept.
The first way is to restrict NHS dentistry to certain groups of people, say children, those who cannot afford private fees and perhaps the elderly. This is not uncommon in the rest of Europe, with those that pay being covered by some form of insurance, but it is unknown here and provably politically unacceptable. It would be seen as 'privatisation' of the NHS and an increased burden on the 'squeezed middle'.
The other way is to pick treatments that will be available and those that can only be provided privately. We all have our favourites for the latter, veneers, crowns, metal dentures and bridges. Some will add molar endo on the grounds that a shortened dental arch is quite acceptable, for our patients of course, not for us.
Such a concept is often described by politicians and political advisers as a 'poor service for poor people'. It is also not what the Government intends for the rest of the NHS. There the so-called 'Nicholson challenge' calls for four per cent efficiency savings every year for the remainder of this Parliament.
Although NHS funding will increase each year, it will be expected to absorb increased demand from an older, fatter and more diabetic population within this same pot of funding. In dentistry we will be expected to see more patients for the same money. So much for the season of goodwill.
But then I wonder if we haven't already introduced a core service by stealth. Since 2006 we have taken fewer radiographs, done less endodontics, provided fewer crowns, veneers and metal dentures. What of the future when the clinical care pathways, currently being piloted come into practice?
Your computer programme will decide that the recall interval for most patients will increase and so called 'complex' work will only be available for those with no risk of further disease. A core service in all but name. When some bright spark in the Treasury realises that we are doing 'less work' how long before they say 'core fees for a core service'?
On that cheering note I will leave you for another year, wishing you compliments of the season and a good rest ready for 2012.