Making prevention pay P
ROFESSOR Jimmy Steele is head of the School of Dental Sciences at Newcastle University and a practising
consultant in restorative dentistry with Newcastle Upon Tyne Hospitals NHS Foundation Trust. His main research interest is population oral health and oral health services, including policy and economics. In 2009 he led the Review of NHS Dental
Services in England for the Government and since then has been working with the Department of Health to pilot a new NHS dental contract based on the recommendations.
Why is a new dental contract needed? Well, there are many reasons and it gets quite complicated but the main one really is that the original NHS contract was set up in 1948 and the dental world is unrecognisably different. Sometimes old things are good but during the intervening (nearly) 70 years oral health right across the UK has been transformed. In 1968, 37 per cent of British adults had complete dentures but by 2009 it was about six per cent, and now it will be even less. Caries
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Professor Jimmy Steele discusses the ethos behind the proposed new NHS dental contract in England and progress in the pilot implementation
which were once universal, whilst now still common, affect the population in a different way. Tere are hordes of people whose risks are lower, but a minority whose risks are high and are oſten from a different sector of society from the low-risk people. Periodontal disease is a bigger problem and needs a different strategy of management. Te old contract evolved a little but not enough to really meet this need. When a new contract was introduced in England in 2006 it really didn’t solve the problem. If we are to use our scarce resources and our improved clinical evidence and knowledge better, we need to structure the payment system to allow that.
What is the ethos behind the new approach? Te National Health Service is about health, not just about treatment – and dental treatment can be damaging as well as good, of course. Te most common dental diseases and conditions are preventable and we will never succeed in treating them away. Te ethos is to make sure that the drivers in the system are for dentists to look aſter the health of their patients rather than only chase treatment targets – in other words to find ways to reward better health. Of course, that needs to be balanced against making sure that the people who most need active and complex treatment can get it.
Te NHS dental contract pilots began in 2011. What aspects are working best? Dentists get the need for prevention, and whether we are talking about dentists who are taking part in the pilots or prototypes or the much larger number still in the old system, there is a general shiſt towards a different philosophy and the language is oſten about prevention. For those working in the pilots (and now the prototypes) they
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PHOTOGRAPHS: NEWCASTLE UNIVERSITY
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