Memories can be such troublesome things, cast your mind back to 2005. There were pilots in the form of PDS contracts and there was work on drafting of a new contract together with the reorganisation of PCTs. All were all in the mix ahead of April 2006.

When I was young I would often travel to Southern Ireland with my parents to visit relatives and the stories of road signs in Eire are indeed true. They rarely have reliability and when you stop a local farmer for directions they really do say,” I wouldn’t be starting from here! "

If you were planning to create a new contract for NHS Dentistry would you choose to do it at the same time as the NHS is about to undergo revolution following the “Liberating the NHS” White Paper. Sadly we appear to have no choice as the coalition seems committed to tearing up the contracts of 2006, matching a time line to exterminate PCTs and develop a National Commissioning Board. Is this the perfect storm?

Lord Howe is set next month to announce the details of the Pilots arising out of the Steele Review. Following the collaborative work of the DoH and GDPC and others, the Minister has taken the summer to analyse the work that started in the dying days of the previous administration. This work has been finalised and presented to the Minister, together with civil service advice decisions will be made on numbers and pilot options. Presumably, if there is no need for legislative changes and the timetable is not delayed, they are due to start in April next year.

To be significant these pilots must at least run for 18 months which flow into the jurisdiction of a National Commissioning Board, which starts in shadow form from the expected start date of the pilots.

I recently attended a meeting in my region of large numbers of PCT personnel and the Secretaries of Local Representative Committees, Local Dental, Medical, Pharmacy and Optical. I had attended hoping to hear “the plan” of how the transition from PCT to NCB/Consortia was to happen. Within five minutes of the meeting starting, it was clear that I was there to help draft the plan rather than be told it!! There is no road map and a real risk of a car crash for NHS Dentistry unless the SatNav is activated and with the assistance of local practitioners and LDCs.

It is times like this that you realise modern management planning meetings have become surreal. Groups of people are separated to carry out almost nursery school tasks, such as drawing cartoons to illustrate your plan and enhancing it with pictures pre-prepared by your facilitator!!! It would be marvellous to think abolishing PCTs will see the end of such tripe, but sadly such techniques are probably so ingrained anything that follows may well adopt similar technique for “brainstorming”. Blue sky thinking replaced by horizon shifts, the lingo will change but what direction are we travelling?

Is there anyone apart from the DoH, who believes the process will not cost a fortune and potentially consortia will save nothing in management costs? With presumably my meeting being replicated all over the country and consultants such as KMPG doing financial risk work, there should be no doubt this will not be a cheap transition.

I can say with honesty we have experienced the highs and lows of PCT engagement, from the frank incompetence to the inspiration of joint working to benefit colleagues and patients. As someone with human feelings one must have sympathy with anyone who has the uncertainty of losing a job and all the issues that go along with that.

 

There is real danger that most of the competent leave early and dentists are left dealing with reduced numbers of personnel and the least able to contract manage us through the transition.

GP Consortia under the term of “pathfinders” are already being encouraged by Andrew Lansley. Weeks seem to change the thinking of the Secretary of State despite writing to GPs in September stating that there was no rush to form consortia; he changed his tune in a speech to the National Association of Primary Care Conference (NAPC) less than a month later. Andrew Lansley was Shadow DoH Secretary for many years and had drawn up a plan to devolve budgets to GPs ahead of the election, local accountability and local authority involvement are Liberal Democratic plans mixed into the coalition soup of ideas.

NAPC is an organisation epitomised by taking forward the agenda of GP Commissioning and full of members that relish this opportunity. This enthusiasm is not shared by GPs in my area where only 19% bothered to reply to an LMC questionnaire on thoughts about consortia size. These consortia even in shadow form will bleed the best from PCTs at the earliest opportunity.

We have seen in dentistry since 2006, how enthusiasts for tendering have transformed the delivery of new service, some might say for the worse. The process has deterred many of the traditional providers and these lessons should not be forgotten as we enter an even more commercial NHS.

So what is the best way to preserve a workforce that can make decisions about dentistry and help preserve the dental budget from attack after the supposed “ring-fence” is lifted at the end of March 2011? What was clear from the meeting I attended was the desire of the PCTs to work collectively in a “cluster” to preserve a work force at least knowing what a UDA and HTM 01 05 is.

Unless there is some collective work with the profession locally and nationally, we have the recipe for a disaster that will make 2006 look well planned. The clock is ticking on change and we must be prepared.

Eddie Crouch