Commissioning NHS Dentistry: The Future

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Delivering for patients Liz Phelps Social
Policy Officer
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Reforms welcomed

• PCT duty to meet all reasonable requirements
• Ring fenced budgets
• Simpler charges
• BUT
• budgets based on historic spend - PCTs not
  starting from the same base line
• SO existing access inequalities entrenched AND
• Very disappointing that first year figures show
  no overall increase in patient access

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The CAB service

• Over 3,000 outlets of which
• Over 1,000 in healthcare settings
• 3,500 enquiries on dentistry between April and
  September 2006 of which
• 35 on access problems

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CAB report Gaps to fill (March 07)

• Feedback from bureaux
• Online survey of access problems May Nov 2006
• Analysis of nhs Direct website November 2006
• Responses from 40 PCTs with access problems

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Key findings - information provision

• Many patients who couldnt find a dentist were
  not using the best search strategy
• only 52 used NHS direct website
• Only 19 telephoned PCT or PALS
• Finding out about waiting lists is not easy
• PCT promotion varied
• NHS direct website was not helpful

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Key findings gaps in provision

• Still significant postcode lottery at the
  national level
• Analysis of NHS Direct website information on
  access for charge paying adults November 2006
• 22 of PCTs showed at least 40 open lists for
  charge paying adults, whereas 26 (40) showed
  none.
• Gaps at the local level
• Long waits (some 12 months or more)
• Lengthy journeys
• Car ownership links to income
• Public transport complex journeys, mobility
  issues
• Cost no help through benefits system
• Patients priority is for a local service

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Key findings alternative strategies

• 9 wait for emergency
• 19 went private
• 65 went without

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Meeting all reasonable requirements?

• Or commissioning to spend ring fenced budget?
• Adequacy of relying on waiting lists and
  enquiries to assess demand?
• Only one of PCTs contacted had undertaken a local
  patient survey
• Few consulting with patient bodies such as PPI
  forums

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Conclusions and recommendations

• Reforms provide sound basis but much to do
• Key recommendations
• Additional funding targeted at PCTs with worst
  access
• Locally set access targets
• Continue ring fencing until targets met

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Conclusions and recommendations

• PCTs need to develop patient facing role
• Assessing demand
• Patient surveys
• Promoting how to find
• Publicising waiting list and how to join
• NHS branded ad in yellow pages
• Targeted information for patients receiving
  emergency only provision or where contracted
  dentist contract ceases
• Assessing patient satisfaction

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