Implementing the NHS dental reforms

• Abstract
• Characteristics of this policy
• Purpose and process analysis
• Expected outcome
• References

Featured in half-yearly report: G-politik in Industrieländern 7/8

Abstract

In April 2006 a new remuneration system for NHS dentists was implemented so that all dental treatment fits into three broad payment bands. The maximum out-of-pocket payment patients have to face will fall from £384 to £189. Dentists will now be paid through a local primary care trust which means that the trust will be able to commission new dental services immediately should any particular dentist decide to terminate or reduce their NHS commitment.

Neue Entwicklungen

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral
current    previous

Overall, this policy seems to me to be innovative and sensible, and for the first time might get at some of the problems that have been associated with NHS dentistry over the years (e.g. supplier-induced demand, inappropriate treatment, inequity of access for high cost treatments and due to dentists leaving the NHS service in certain geographical locations). Much of the dentists' traditional dissatisfaction with the NHS (and hence for some of them to leave the NHS) has been driven by uncertainty over the fee schedule. By guaranteeing incomes, the Government seems to be addressing this problem, although one hopes that for the sake of financial viability, incomes have not been guaranteed at too high a level.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Initiators of idea/main actors

• Regierung: The Government is the main actor in implementing this policy, and thus it is very supportive of the policy and its influence is very strong. It has called these the biggest NHS dental reforms since 1948. According to Government reports, the dentists themselves requested the new arrangements, so it can also be presumed that their support and influence is strong. Indeed, the Government has promoted the reforms as an excellent deal for dentists, which is hard to argue against. For example, dentists will have the security of a guaranteed annual NHS income (of an average of around 80,000 pounds sterling per year, after practice costs), will for the next three years give them guaranteed contracts that are worth at least the value of their current NHS earnings, but with an agreed 5% reduction in the courses of treatment to allow them to spend more time on each patient?s preventative dental care needs, and will offer them the benefits of a generous NHS pension scheme.

Stakeholder positions

According to Government statements, there seems to be no major opponents of the policy proposals. However, the Government has also announced that they are aware that some people have expressed concern regarding the future impact of these quite fundamental reforms, and this is why the Government has established an implementation group to monitor the progress of the reforms. The implementation group comprises of members of the key stakeholder groups - i.e. the Britsh Dental Association, The Consumers Association, the Citizens Advice Bureau, the British Orthodontic Society, the Dental Laboratories Association, and the Dental Practive Division of the NHS Business Services Authority. 

Actors and positions

Regierung
Government	sehr unterstützend		stark dagegen
British Dental Association	sehr unterstützend		stark dagegen
Individual dentists	sehr unterstützend		stark dagegen
current    previous

Influences in policy making and legislation

Following a period of consultation where the Government reportedly listened to the views of the dental profession, the reforms were implemented in their entirety in April 2006.

Legislative outcome

Enactment

Actors and influence

Regierung
Government	sehr groß		kein
British Dental Association	sehr groß		kein
Individual dentists	sehr groß		kein
current    previous

Positions and Influences at a glance

Adoption and implementation

The proposals have only just been implemented (in April 2006), so we will have to wait until then to see if they are successful. There have, however, been pilot projects that have involved 30% of dentists, and in these a 30% reduction in the individual items of service carried out within a typical course of treatment have been observed. The Government has argued that this frees up capacity for the dentists to spend more time with the individual patients. However, this observation is only a good thing if the items that the dentists are cutting back on are unneeded items of care (i.e. that the dentists were originally generating significant supplier-induced demand so as to maximize their incomes). Whilst this was probably the case, we cannot rule out entirely the possibility that the dentists have cut back on necessary items of care, and I would guess that this will be something the implementation group will assess once the reforms are implemented in full.

Monitoring and evaluation

As noted in the previous report (6(2005), since the contracting of dental services will be undertaken by primary care trusts, the PCTs will have to monitor dental practices to some extent. However, the main monitoring task on a national level will be undertaken by the Government's newly established implementation group, comprising of representatives of most of the key stakeholders (detailed above). 

Expected outcome

The impact of the new dental policy remains to be seen, but it does sound promising. It seems to tackle the problems of supplier-induced demand and the incentives to undertake outdated (i.e. restorative rather than preventative) modes of treatment that have been endemic to NHS dental care for decades. Moreover, it reduces out-of pocket costs for very expensive treatments that were previously probably prohibitive to some people, and it maintains the current system of exemptions (e.g. children, pregnant women etc). It also explicitly bans certain unacceptable practices by dentists, such as only accepting children as NHS patients if their parents register as private patients. I would expect the reforms as a whole to have a positive impact, but to reiterate, only time will tell.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch
current    previous

Too early to tell, but the policy (and the results of the pilot projects) is promising.

References

Sources of Information

Department of Health. Implementation group invited to give dental reforms regular check up. Department of Health, London, March 7th 2006

Reform formerly reported in

Dental Policy: Knights, Knaves and Gnashers Process Stages: Umsetzung, Strategiepapier, Gesetzgebung, Idee, Pilotprojekt

Increasing NHS dental service capacity Process Stages: Umsetzung, Strategiepapier

Reforming NHS Dentistry Process Stages: Strategiepapier, Pilotprojekt

Author/s and/or contributors to this survey

Adam Oliver

Empfohlene Zitierweise für diesen Online-Artikel:

Adam Oliver. "Implementing the NHS dental reforms". Health Policy Monitor, Implementing the NHS dental reforms. Available at http://www.hpm.org/survey/gb/a7/5