NHS work stabilised at all time low
As predicted in the April issue of DentalLab, the fourth
quarter (1 January to 31 March 2007) NHS dental statistics
for England show that items of treatment containing a
laboratory component have stabilised at an all time low,
again being at 56 per cent of what they were under the
old item of service system, accounting for only 4.5 per
cent of courses of treatment.
Just what the Department does about this, given that, until April 2009, UDAs contain allowances, including laboratory fees, for the practitioner’s prescribing patterns under the old system, remains to be seen. But the message is loud and clear for laboratories still heavily reliant on NHS work to diversify and move into the private sector before its too late.
The figures give credence to the DLA’s findings from its surveys of dental laboratories that demand for individual items under the NHS fell from between 42 per cent for non-precious crowns to 84 per cent for NHS precious bonded crowns five months into the new arrangements in England and Wales. The work being undertaken within band three is also very different to what was being done under item of service, with the surveys showing a 78 per cent increase in demand for single tooth dentures.
This double whammy for laboratories has resulted in unprecedented bankruptcies of DLA member businesses and 5 per cent of the workforce being made redundant since the introduction of PCT commissioning of NHS services in England and Wales.
As reported in April, the DLA’s
surveys are at present the only
source of information on what is
being provided under this wide
ranging treatment band, which
is why the DLA is working with
the Department of Health on
future surveys. This will ensure
that what emerges is accepted by all as a true picture of what is happening, informing the Dental Review Group, on which the DLA sits and established to monitor the new arrangements.
A summary of the first year of the new contract should have been published by The NHS Information Centre last month, which I will review in the next issue of dental lab, but again the proportion of band 1 (diagnoses, treatment planning and maintenance), band 2 (fillings, extractions and endodontics), urgent and ‘other’ courses of treatment were remarkably similar to the previous quarter. These were for band 1: 53.4 percent in Q4 compared to 53.6 per cent in Q3; band 2: 30.6 per cent compared to 30.5 per cent; urgent: 8.9 per cent compared to 8.3 per cent; and ‘other’: 2.6 per cent compared to 3 per cent.
What is interesting is the size of urgent courses of treatment, which is not directly comparable to items of treatment under the old item of service system. The number of GDPs in England providing NHS dentistry continues to rise at 21,038 compared to 20,887 in Q3, almost recovering to the pre new contract level of 21,111 which fell by just over 1,600 following its introduction. The number of patients seen under the NHS has also remained remarkably stable at 28.1 million in the previous 24 months for both quarters, with the breakdown between adults and children being the same at 20.3 million and 7.8 respectively and also showing little change from the period ending 31 March 2006.
This means that 55.7 per cent of the population had seen an NHS dentist in the previous 24 month period to 31 March 2007, comprising of 51.5 per cent of adults and 70.7 per cent of children – again, exactly the same as in the previous quarter. Of course we are only into a year of the new contract and its impact might be dampened but if significantly more or less patients
were being seen this would d be apparent.
So what does all this mean?
Well certainly access has not improved, although the mass exodus of dentists from the NHS predicted by some has not occurred, but this may change from April 2009 when the dental budget is no longer ring fenced. It could be that practitioners are preparing for this by still seeing patients under the NHS as indicated by the number of patients seen and a slight increase in band 1 treatments, approximately 50 per cent under the old item of service (IOS) system, but doing less NHS work. This is not only borne out by the dramatic fall in band 3 treatments but also band 2, which were about 42 per cent of IOS. The question is whether there is a direct substitution of private work?
The DLA survey does show an increase in the number of private units being supplied but these are still less than the fall in the number of NHS – for example, the number of units of private dentures increased by 42 per cent whereas the number of NHS fell by 63 per cent during the first five moths of the new contract. So although at first sight all looks very stable, as we know, a lot of change is occurring under the surface.
To view the fourth quarter report visit www.ic.nhs.uk.
