In the UK, and particularly England, we have a unique opportunity to change the future of dentistry. As GDPs there are lots of things that we probably cannot change on our own but at the same time there are lots of things that we could change if we worked together. In particular there is the role of GDPs in primary care research.
For example, it’s unlikely that most general practitioners will be able to design and test new technology or a procedure in a general practice setting. This type of work will often need to take place in collaboration with academic colleagues usually in a very controlled environment. However, we are able to get involved with randomised controlled trials and other community based studies. Recently there have been a few studies that have been based in primary care and have provided GDPs the opportunity to participate.
Although it seems like much more could be done to utilise the opportunity that is offered in primary care. Primary care provides an excellent opportunity to find out about what motivates patients to attend the dentist and what those patients expect from the NHS, at the same time we could also find out what it is that patients do not expect from the NHS.
In the NHS, there was a very long period of time when GDPs submitted detailed clinical information about treatment provided. It seems unlikely that there could have been a larger data warehouse than this anywhere in Europe or perhaps even the Western world, yet for a range of reasons this process ceased to exist in 2006. In retrospect, it seems like a lost opportunity as the profession and the Government had a real opportunity to follow the ‘end to end’ journey of a patient and perhaps even calculate the cost effectiveness of NHS treatment options. No doubt there were reasons why this was probably not favourable at the time and hard decisions had to be made.
As NHS dentistry in England moves in to the new world of the commissioning board, could there be an opportunity to harness the role of evidence based dentistry once again? If we really want to know whether or not applying fluoride varnish to large groups of the population has any effect on their long term oral health, then perhaps we need to start collecting longitudinal clinical data again in the setting in which we are actually working. Of course, there will be all the methodological arguments to deal with such as how we measure and value NHS treatment, however with a big enough pool of NHS dentists these differences should even out. The involvement of NHS dentists within primary care research should not be controversial and is not a new concept, it just needs to be well supported and funded to enable the population to benefit in the longer term.
The NHS already undertakes a number of epidemiological surveys which are very useful and have their place in forming high level strategy. However, the samples involved are often a very small proportion of the population. It would be hard for commissioners to make a new commissioning decision based on these surveys. However, local primary care intelligence may be an alternative.
In order to change health policy, the profession needs evidence with which it is possible to enter meaningful discussion with policy makers. In my view, the Government needs to make it easier for a wider group of NHS dentists to participate in research so that high quality evidence can be gathered to help shape policy. We need to recover our lost treasure and use the power of evidence from primary care.