Dentists in England have suffered and there was a time, not very long ago now, when the future did not look bright. If I’d suggested two years ago that it would be only 24 months until we’d be piloting a new contract based on capitation, quality payments and no UDAs, I’d have been greeted by wall-to-wall scepticism. And yet we’re here. The principles of Steele have navigated a change of Government and, hearteningly, with the presence of GDPC Vice Chair Henrik Overgaard-Nielsen and me on the steering group that has developed pilots, the profession has had meaningful input into their design. Both of us are practising dentists and understand the challenges of working ethically within the NHS system.
That’s just the beginning of course. The hard work starts now and dentists and Government alike need to roll up their sleeves and get on with it. We’ll need an ethical and honest approach that seeks not the lowest price for the NHS or minimal care from practitioners, but instead recognises that cheap and good are rarely the same thing and instead holds quality as its ideal. We must provide that quality in our care, and Government must provide that quality with its funding.
Every dentist can think of examples that illustrate this point. The right care must be provided because of the system, not despite it. If patients need chrome dentures or crowns, or molar endodontics, then these should be provided. Prevention needs time and resources too if it is to be done as it should, and the switch from a target-driven approach will be a culture shift that will require us to learn new behaviours and work out exactly how a new contract should be structured. GDPC hopes that a properly-funded capitation-based system will give practitioners the freedom to provide the care that even the most challenging patients require. We will need to press strongly for sufficient funding to meet the clinical needs that are identified within practice populations.
As we move forward all parties need to be realistic. When challenges arrive, as they almost certainly will, all concerned must hold their nerve. Problems can and should be learnt from. The path to a new contract won’t always be easy, but it’s one that we must tread determinedly. By confronting problems sensibly we give ourselves the best possible chance of delivering improved oral health, a quality service and better working lives – achieving a win for patients, dentists and Government alike.
The pilots must develop a process for implementing a new contract that makes the NHS a place that the profession is proud to work in. Getting to that stage will mean answering lots of questions, including many that will only arise as the pilots progress. I wish colleagues participating in them well.

John Milne
8th June 2011

Note for readers: A donation to the BDA Benfund will be made by GDPUK Ltd for this article.

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