NHS laboratory items still at an all time low and look like staying there… is Private Dentistry the only option?
By Stephen Tidman
Despite some sleight of hand, if not spin, third quarter statistics on the new contract in England show that treatments involving laboratory items, band 3, have stabilised at around 56 per cent of what they were under the old item of service contract.
In a press release, issued by The Information Centre accompanying publication of the figures, it was stated that ‘Courses including treatments which require laboratory work such as crowns, dentures and bridges (Band 3), which take longer to complete (sic), have increased from 3.3 per cent in quarter 1 to 4.3 per cent in quarter 2 and 4.5 per cent in
quarter 3.’ It was inevitable that the second quarter would show an increase on the first quarter, as the latter was significantly deflated by general dental practitioners (GDPs) providing, wherever possible, treatment involving laboratory work before April 1 2006 to benefit from the old fee scale. So it is misleading to use this as a base. Indeed, the report itself acknowledges elsewhere that quarter 1 was ‘atypical’.
What is important is that treatment involving laboratory work under the old system accounted for around 8 per cent of the total courses of treatment provided and although showing a slight increase on the second quarter, this seems to be settling down at around 4.5 per cent. This is borne out by the DLA’s surveys of laboratories. These also show what is being provided under this wide ranging treatment band – the problem is that in moving to treatment bands, items of treatment are no longer identified on the FP17 and at present the surveys are the only source of information on what is being provided. The DLA is NHS laboratory items still at an all time low and look like staying there working with the Department of Health on future surveys to ensure that what emerges is accepted by all as a true picture of what is happening and can inform the Dental Review Group - established to monitor the new arrangements and on which the DLA sits.
The other treatment bands also show remarkable similarity to the previous quarter prompting Professor Denise Lievesley,
Chief Executive of The Information Centre, to say that the figures ‘show that the new system is settling down’. The largest was band 1 (diagnosis, treatment planning and maintenance) accounting for 53.6 per cent of courses of treatment (54.5 per cent in Q2) followed by band 2 (treatment including fillings, endodontics and extractions) at 30.5 per cent (30.6 per cent in Q2). These compare to 50 per cent and 42 per cent respectively under the old contract. The surprise is urgent treatment, not directly comparable under the old fee scale, accounting for 8.3 per cent (7.9 per cent in Q2) and ‘other’ at 3 per cent (2.8 per cent in Q2) completing the picture.
There were 20,887 GDPs providing NHS dentistry in England at 31 December 2006. This means that numbers have almost recovered to the 21,111 in contract on the eve of introduction of the new arrangements on 31 March 2006. Numbers fell to 19,462 at the end of the first quarter, primarily as a result of 2,000 or so GDPs who decided against or did not have their contracts renewed. These practitioners accounted for only 4 per cent of NHS activity, which was soon recomissioned.
It appears that roughly the same number of patients are being seen as under the old contract, despite courses of treatment
falling, so access has not improved. For example, dentists saw 28.1 million patients (20.3 million adults and 7.8 million children) under the NHS in the 24 months ending 31 December 2006 compared to 28.2 million (20.4 million adults and 7.8 million children) in the 24 months ending 31 March 2006. This means that 55.7 per cent of the population or 51.5 per cent of adults and 70.5 per cent of children received treatment under the NHS in the 24 months to 31 December 2006. Of course, with only 9 months of the 24 occurring under the new contract, its impact might be dampened but if significantly more or less patients were being seen this would be apparent.
As I write, there is renewed controversy about the availability of NHS dentistry, with talk of ‘dental deserts’, following
publication of Gaps to fill - Citizens Advice Bureau evidence on the first year of the NHS dentistry reforms. What is perhaps surprising is that this report, along with all others, has not identified cost, in the form of patient charges, as being a problem once access to an NHS dentist has been achieved. This is perhaps a consequence of the exclusive Government
focus on the simplicity of the new charging system and a reduction in patient charges - comparing the maximum charge of £378 under the old system with the £198 under the new arrangements. What has been avoided, at all cost, is the massive increase in patient charges for individual items of treatment, for example, more than doubling the charge for a bonded crown which anecdotal evidence suggests has led to some patients opting for extraction rather than restoration.
There is also the underlying problem that the maximum charge of £378 was reached where the patient received a number of treatments, with the GDP receiving a fee for each treatment. Under the new system, although GDPs’ previous prescribing patterns and remuneration were used to arrive at their contract and UDA values, they only receive one fee (3 times the value of their UDAs for band 2 treatments and 12 times the value of their UDAs for band 3 treatments), irrespective of how many treatments are provided.
It is therefore inevitable that, given the financial pressures on general practice, the minimum amount of treatment will be provided within each of these bands and the days of multiple treatments under the NHS have gone. This is quite apart
from what appears to be quite dramatic changes in what patients are being prescribed, which brings us back to the DLA’s survey and the importance of participating.
For a copy of the third quarter report see: http://www.ic.nhs.uk/pubs/dental06q3
