Q&A
seem genuinely to be managing risks rather than chasing UDA (unit of dental activity) targets.
What are proving to be major challenges? All change is difficult. It requires a new way of thinking and that is really hard. Some of this is about management within the practice. Where the principals have thought it through and planned and made changes from day one and got buy-in from the practices, then it has worked okay, though of course the change was still a challenge. Where that did not happen and people pretended that nothing needed to be done differently – then there have been bigger problems.
How have patients responded? Tey actually seemed to respond very well. Some data aſter a couple of years showed a reduction of moderate periodontal disease by about a third because it had been detected and managed appropriately. Patients seem to like having a conversation about their own oral health in a way that has never happened before. Te pilots are just a first run-through though, a dress rehearsal and like any dress rehearsal, a lot has been learned. As we move through prototypes it should be tighter but there is yet more learning required.
Is there any one model of dental remuneration emerging as most effective? Every variation has been revealing but the move now has been to have a proportion of the contract paid per patient (and if patients are lost to the practice that contract will come down), but that some will pay for aspects of treatment. Tere are nuances within that but it is too early to tell. My feeling is that it makes sense to set the capitation fee to include caries and periodontal disease management as well as prevention, but to separate out the more complex care into the fee-for-service element because there is a real incentive to get the prevention to work and to think that through. Tat way you get paid the same but need to do less routine treatment.
How will the new contract be funded and will additional funding be available? In a world where there is little more money anywhere near the NHS, no-one will put
AUTUMN 2015
more money in I’m afraid. If we had done this a decade ago we would have been able to oil the wheels I am sure with a bit of resource; now being realistic that will not be the case. However, it makes people a little more imaginative in finding solutions, so what has now been done is to reduce the treatment targets substantially in the prototypes in order to create time for prevention and to try to ensure that treatments go where they are most needed. Tis has been a major step-change. It is not new money but a huge shiſt in emphasis and although it needs a bit of ironing out it is, in my view, very important.
How did you get involved in reforming dental practice? Well, it was never intended! I knew all about the population trends in disease which were so dramatic and was happy to comment on that, which led naturally into how we might need to manage services differently. I got asked to lead the review of NHS dentistry in England at the back end of 2008 I think because I had said quite a lot up to that point. It was really challenging but ultimately reasonably well received at the time, so I was asked to continue to have input. What you realise is that recommendations and ideas are easy. Implementation is incredibly complicated. I get a bit frustrated now when people complain about how we should just change this or change that – changing an entire national system is fabulously complex. I think sometimes people think that I make the decisions, but I really do not. Civil servants and their teams on behalf of politicians and the NHS bureaucrats make the decisions. Maintaining continuity across two elections has been a particular challenge.
“ The National Health Service is about health, not just about treatment”
How will compliance and quality be ensured? Ah now, that gets complicated. We will need measures in place that are simple and that show whether a practice is improving health or not. Critical to this is a way of collecting some simple data or indices from all practices with the minimum of effort (for example from some simple data in the IT system). Tese will need to change from time-to-time but it is important that practices themselves know how they are doing in health outcomes compared to their peers. Tis is something we have never been very good at, so it is an important part of the process. I have been frustrated that this has not been done as well to date as it should have been because there have been so many things to do that have distracted efforts.
What do you do with the rest of your time (little of it there no doubt is)? Well, I used to be a very good birder (I found the UK’s second ever black-faced bunting in a hedge near the sea in Northumberland and lots of other interesting things) but am not as good as I used to be, largely as I have less time. But in September and October I become obsessional about migration and wind direction. My best find this year as I write this was a Terek sandpiper in north Northumberland in July and if anyone knows about birds they can make a judgement about where that sits in the rare bird pantheon. I did nine years on the British Birds Rarities Committee (until about 2006 I think) and am now on the British Ornithologists Union Records Committee so every now and again I find myself spending a day debating redpoll taxonomy or puffin wing lengths or something – it is a different planet. I also catch lobsters (about 22 last season – very tasty) and cook seafood and gave a couple of courses last summer. So yes, I keep ticking over.
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