Thursday, 26 February 2015

Are you being Pulled out of Orbit? The NHS/Private Interface

I have also discussed this talk on the 2020dentistry blog page.

This post is based on a talk by Raj Rattan at the Young Dentist Conference 2015



Raj Rattan raised important issues and asked “What treatment should be provided on the NHS?” this is what he said:

All treatments that are proper and necessary to secure and maintain oral health should be provided under the National Health Service.
Most NHS dentists will hold General Dental Service contracts, but additional services can be provided if the dentist has been contracted to carry them out. These include:
  • Dental Public Health services
  • Sedation services
  • Domiciliary services
  • Orthodontic services
  • Advanced Mandatory services.
What are Advanced Mandatory services?

A service which provides a high level of expertise and facilities where general practitioners can refer their patients for specialist periodontal or endodontic treatments.

There are several guidelines available that assess the complexity of the treatment required for a patient, which can be used to determine whether a referral to an advanced mandatory service is indicated, and include guidelines from:

  • American Association of Endodontics
  • British Society of Periodontics
  • NHS Restorative Dentistry: Index of Treatment Need Complexity Assessment

The most common treatments that are ‘pushed privately’ by dentists who violate the terms of their NHS contract and do not follow the GDC Standards of Care are:

  1. Cobalt Chrome Dentures
  2. Periodontal treatment and referrals to hygienists
  3. Bridgework
  4. Endodontic treatment
As professionals, we are trained as clinicians, and not business managers, and this brings me to the issues of: time, quality and money, and how well equipped are we to deliver.

Ideally, we all would like to perform highly in all of the above, but unfortunately this is often not possible. It has been estimated that around £72 million was inappropriately claimed by gaming dentists; 50% of this were treatments claimed which the patient didn't actually receive. This is not in the interest of the profession or the patients.



Dentists are also under pressure to be transparent in their pricing by the Office of Fair Trading, more recently by Which? and to be CQC compliant. The profession therefore need to have a conversation on how best to use their clinical skills and the settings to deliver dental care.



To see another post about a talk about NHS Rules and Regulations by Raj Rattan and Len D'Cruz click here.



See my new post about a talk by Reena Wadia at the Young Dentist Conference, How to survive as a young dentist?




Do you have trouble understanding what treatments you can provide your patients on the NHS? Or have views on the proposed new contact? Please leave your comments in the section below!



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