August 2010 Michael Watson


Say goodbye to PCTs A


NDREW Lansley’s comment that Primary Care Trusts will go in 2013, because


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they will then no longer have a role, shows a lamentable lack of understanding about how the NHS works. It pampers to the notion that healthcare is all about hospitals and nothing else. For Lansley to say this, when he


had shadowed health for seven years, before becoming a minister, demonstrates his complete ignorance about healthcare and the NHS. As readers of this column know, I


am no fan of PCTs, but there will still be a role for something even after 2013. Instead of which the whole of primary care is being entrusted to a National Commissioning Board, which will have little or no local knowledge. Sitting at the back of the press


briefing when the White Paper was launched, all I heard about was hospitals, hospitals and hospitals. The entire focus was on heart operations, stroke, cancer care and choosing your consultant. Of course these are important. If


and when I am admitted to hospital, I want to be discharged with a cure, not MRSA. But, Mr Lansley, far more people visit their doctor, dentist or pharmacy every day than end up in hospital. Primary care, and that includes


dentistry, is the shop window of the NHS. Patients judge the NHS by what is in the shop window, how it affects them directly, more than targets and statistics for hospital care. Primary Care Trusts should be


looking after primary care. In reality they have concentrated on their commissioning role and managing contracts for primary care providers and making some dentists’ lives a misery into the bargain. In dentistry, they should have


been looking at how dentistry and especially prevention could be delivered to specific groups in the population: children, the elderly, and the homeless. They should have been seeing that


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urgent care was delivered properly as well as more complex care, oral surgery, endodontics, perio and restorative dentistry. Instead of which they have been fretting over UDA values and delivery. In dentistry and across other areas


of primary care, they have simply not been doing their job properly. Lansley’s answer is not to make sure


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they do their job but to abolish them, in the process transferring their vital public health functions to, of all people, local authorities.


New contract The White Paper brings a new slogan: “nothing about me without me”. Patients should be involved in decisions made about their health, it says. One sentence in it (para 2.3)


could and should apply to dentistry in general practice: “International evidence shows that involving patients in their care and treatment improves their health outcomes, boosts their satisfaction with services received, and increases not just their knowledge and understanding of their health status but also their adherence to a chosen treatment.” Dentists know in their daily practice


that all the finest restorative work will be put in jeopardy if the patient neglects to maintain their oral health.


PCTs should be looking after primary care. They have concentrated on commissioning and managing contracts for primary care providers and making dentists’ lives a misery into the bargain.


If the proposed new contract


concentrates on that sentence and discards all the extraneous matters such as targets, units of dental activity and clawbacks, then there may be some hope for a new national contract. I have to say, however, that I


remain sceptical. Bureaucracy has a way of getting in the way of good oral health. I am not the only one to be


sceptical about this new regime and its ability to save money. Kieran Walshe, Professor of Health Policy and Management at Manchester Business School, writing in the British Medical Journal, says the major re- organisation is based on no evidence that it will lead to improvements. Restructuring the NHS according to government plans will cost between


£2 billion and £3 billion, with no guarantee of better care for patients, he says. Professor


Walshe said that “little of the current architecture of the NHS will survive these changes unscathed”, despite Conservative pledges during this year’s election campaign to stop the top-down re-organisations. Restructuring the NHS was a “huge


distraction from the real mission of the NHS – to deliver and improve the quality of healthcare”, he added. The think-tank Civitas looked at


the effect of re-organisation on the NHS studying the effect, in 2006, of the reduction in the number of PCTs from 302 to 152, when performance dropped in those that had merged compared with those that were unchanged. It concluded: “If the kind of


performance drop seen with the merging of PCTs in 2006 – a comparatively minor change – is repeated with current government plans, the NHS will have a major problem. “The bulk of proposed NHS


efficiency savings rely on efficiencies driven by commissioning, yet the evidence presented suggests that these would not be made.” Civitas could also have looked at


the other change that happened in 2006 – the introduction of the new dental contract. No one, not even the Department


of Health, can deny that performance has dropped. Fewer patients were seen, fewer complex treatments have been carried out, despite a large increase in funding. It is going to have to be a brilliant new contract that solves this problem.


Back to the GDC The Council for Healthcare Regulatory Excellence’s (CHRE) report on the fitness to practise procedures of the General Dental Council makes depressing reading. I took the GDC to task earlier


this year for its secret sessions and insistence that all was well. We now have proof from the GDC’s own regulator that it wasn’t. It is going to cost money, dentists’


and other registrants’ money, to put matters right.


www.dental-practice.org


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