How to make friends and influence people
By Stephen Tidman
The DLA had the foresight to begin its surveys during the piloting of the primary dental services (PDS), the precursor to the devolution of the general dental services to primary care trusts. The results of this survey confirmed what was being rumoured – a significant fall in more complex treatments containing an appliance or restoration. Having evidence enabled the DLA to have a meeting with the Health Minister, Rosie Winterton, in January of last year to warn her of the consequences of the changes, a good three months before implementation.
Although unable to get the changes suggested, the DLA was invited to be a member of the Implementation Review Group, joining the BDA, PCTs and patient groups, to monitor the new arrangements on a quarterly basis, with the first meeting held six weeks into the new contract in May. The Minister also agreed to review the monitoring of band 3 treatments.
It was in May that the DLA launched the most ambitious lobbying campaign in its forty-five year history that would have been daunting for a much larger organisation. The Chief Executive, Richard Daniels, spearheaded the campaign, writing to all six hundred and forty six members of Parliament. Richard warned that many NHS patients were not receiving the most appropriate dental healthcare and that this was creating significant redundancies in the dental technology industry. He offered to meet with them either in London or in their constituencies ‘to discuss ways in which we can prevent patients being left without a comprehensive NHS dental service, as well as yet another British manufacturing industry falling by the wayside.’
In all, one hundred and seventy five MPs took up Richard’s offer and he came down to London for weeklong sessions and they even provided him with a desk at the House of Commons! I met Richard during these marathons and I have to say he was relishing and excelling in the challenge but he had to draw on all his reserves of tact and fortitude in dealing with some of the MPs. Members of Parliament are now sent regular updates to keep them informed of what is happening and one, Ann Widdecombe, MP for Maidstone and the Weald, is now on her second fact-finding tour of dental laboratories in her constituency.
The lobbying of MPs was rewarded in September with John Leech, MP for Manchester and Withington, securing a private members’ debate to hear the Minister for Health Rosie Winterton's response ‘to the legitimate concern of the dental laboratories profession that the new contract is damaging their industry and, equally importantly, the service provided to patients in the NHS . . . I shall focus on three points: first the impact of the new contract on the availability of certain treatment on the NHS, dentists’ decisions to provide cheaper and less effective treatments and the knock-on effect on dental laboratories; secondly, the influx of cheaper dental appliances from abroad; and finally, the lack of information given to patients about their entitlement to certain dental work.'
John Leech went on to give a very detailed analysis of the situation, extensively quoting from the DLA surveys. As he said, ‘the overall results from the new contract have been startling and prove pretty conclusively, I would argue, that certain dental appliances are not being provided by some dentists under the new contract and that more people are being forced to go private to receive the treatment that they require . . . the Minister cannot argue that she was not warned that that would happen, because in December 2005 she received figures from a survey carried out in the pilot areas in September that year’ before concluding ‘. . . the new contract encourages dentists to offer cheaper alternatives and to drag out treatment time, rather than provide the most appropriate treatment as quickly as possible.’
It was during this debate that Rosie Winterton uttered those immortal words ‘I do not accept that dentists would give in to an incentive and get a few bob more by providing the wrong appliances.’ She stressed the need to monitor the effects of the reforms and acknowledged the fact that under the PDS ‘in some areas, overall activity lessened, which is why we have introduced measurement by units of dental activity . . . the evidence from the pilots showed a certain drop in activity at first but, as they progressed, activity increased.’
But she did say that if the data showed that dentists were ‘not prescribing all the dental appliances for which their patients have a clinical need, we will be able to obtain further information from patient inspections, conducted by the dental reference service (DRS).’ Rosie Winterton also acknowledged that proper regulation was needed for imported dental appliances. The following month, the DLA took its lobbying exercise on the road to PCTs and strategic health authorities in a bid to make a positive impact at a regional level for DLA members.
As part of the monitoring of what is happening to band 3 treatments, the Department of Health is working with the DLA in analysing the results of its surveys to ensure that there is an accurate picture of what patients are receiving and the effects on the industry. This is vitally important work, as the new FP17 does not distinguish what is prescribed under band 3 treatments and the Department has not yet used the DRS to investigate band 3 treatments. The recently published quarterly data for England to the end of September 2006 from the NHS Information Centre (go to: www.ic.nhs.uk), show that the highest courses of treatment were within band 1, at 55 per cent, followed by 30 per cent in band 2 and 4 per cent within band 3.
The issuing of a prescription, urgent and other treatment accounted for 11 per cent. Under the old GDS, around 50 per cent of courses of treatment would have fallen into band 1, 42 per cent in band 2 and 8 per cent in band 3. This means that band 3 treatments are 50 per cent down on what was provided under the GDS and this says nothing about the treatment mix. However, the results of the DLA surveys not only show a dramatic reduction in the prescription of appliances and restorations such as crowns, bridges and chrome dentures but an equally dramatic rise in single tooth dentures and additions to existing dentures where fixed restorations or tooth borne partial dentures would have been provided.
