Sunday, 24 February 2019

Who are NHS England?

You may have heard of NHS England but what do they actually do? Before my fellowship with them this year I only had vague ideas about the role of the organisation. So what have I learnt that they do and how does it relate to dentistry?


A bit of History


Before 1948 and the introduction of the NHS, all dentistry was provided privately. For the first 2 years after the NHS was introduced, dentistry was provided free at point of service, but spiralling costs associated with high numbers of extractions and full dentures lead to the introduction of patient charges in 1951. 

Dentists were paid a fee per item of service which was considered to be complicated and confusing. This was in place until 1992 where a blended style of contract was introduced where there was a payment for capitation and also for quality and continued care. Most recently, the contract changed again in 2006 where our current UDA system came into play as I am sure you're aware where banded treatments simplified the payments patients made if they were fee paying and also for the first time allowed for there to be fixed NHS dentistry budget. Dental Contract Reform has been in place for the last few years where again the contract is going to be changed. 

The commissioning of dentistry has been overseen by NHS England throughout this time - initially known as the NHS Board. Commissioning decisions are now overseen by local teams rather than one central body who hold the budget and providers will be accountable to contractually. 


NHS Structure


NHS England (NHSE) is part of the Department of Health and Social Care (DOHSC) and its responsibilities are set out in the Health and Social Care Act 2012. These are:
  • Planning of NHS services
  • Budgeting of NHS services
  • Day to day delivery of NHS services
  • Responsible for commissioning of NHS services (I will explain this in a future post about the Commissioning Cycle)
  • Hold contracts with doctors and dentists
NHSE are under the Secretary of State of Health and their team at DOHSC (currently Matt Hancock) but are arms length bodies similar to Public Health England (PHE) and Health Education England (HEE). 


The Secretary of State annually publishes the NHS Mandate which sets out the goals NHSE have to work towards in the upcoming year. 


NHSE and Dental Commissioning


Budgets for paying for and commissioning health services are broken down into different teams within NHSE:
  • Clinical Commissioning Groups (CCGs) are given the budget (60% of overall budget) for hospital, urgent, mental health and community services. They co-commission GP services with NHSE
  • Specialised Commissioning e.g. cancer care, secure mental health
  • Dental
  • Optometry
  • Military and veteran health services
  • Health and justice
  • Public Health Commissioning (although the majority of this is commissioned by PHE i.e. local health authorities)
NHSE not only commission the service, they also contract manage and monitor services as well as holding the NHS dental performers list (which was contracted out to Capita in 2014). 



Engagement with the Profession


It is important that commissioners communicate and engage with the profession. For dentistry, there are formal routes that they do this regularly:
  • Local Dental Committees (LDC)- although hosted by the British Dental Association (BDA) are funded from the Levy collected from NHS GDPs through NHSE
  • Local Dental Networks (LDN)
  • Managed Clinical Networks (MCN)

I will blog about these separately. As well as these regular engagements, NHSE can engage with the profession during procurement processes or via professional bodies such as the BDA or other specialty-specific bodies.


I hope this clears up the role of NHSE and how it relates to NHS dentistry!


Do you have any questions? Let me know in the comments below!



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