Enamel Prism

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Direct Access - threat or opportunity?

 


Ta DA  -  here it is folks.

Roll up, Roll up, it’s the finest oil you can buy.

What a week!

Well, what a week it has turned out to be. Just as the BDA go all inclusive on us, ‘inviting’ membership of this august Trade Union-esque body at various levels, they go all protectionist on us with their latest missive [1]. Maybe they are modelled on the old dinosaur Unions after all? What on earth are they on about?  If ever there was a bullet in the foot, this latest BDA tripe is worthy of ribald derision. Whether this stance will prove a monumental cock up or success will of course remain for the future to know.

It all started of course with what many might consider to be perhaps one of the earth shattering weeks in the history of the UK dental profession.   

Actually, not true: it all started with the OFT report of 2012[2] in which the threat of a full market review was hung over the profession and the GDC. The condition for its NOT being actioned was, amongst other things, the opening up of access to DCPs.

The GDC of course like being a strategic body. But I am sure they felt like a rabbit in the headlights of the OFT and an academic onslaught from Dundee, Manchester and Kent.  

With too many opinions to be able to “lead”, they did the classic “Large Committee” thing and sat on the fence examining their navels, asking the whole world what they thought about something of which they had not heard [Evidence Based Policy[3] …  hmmm ]  and then promptly fudged through the Direct Access changes come what may despite many shortcomings and misgivings.

This was not, it might seem, because they genuinely felt it was an appropriate release of professional skills.  It seemed that they were more concerned that having built up such a head of advance steam with the various reports and consultations that the only release was DA at any cost of any sort. Just get the OFT off their backs …

So what have we got? 

Well, on Easter Tuesday, not much has changed. Relax mes amis. 

 

Go to work and start to think about it.  As of March 2013 there are 38777 registered dentists.  There are 6265 hygienists and 2077 therapists, and encouragingly all have a known gender.

 

In practice I simply cannot see how DA will change much – other than oiling the wheels of efficient Dental Health Maintenance.  The need for a periodic dental examination to simply re issue a prescription for care can be eased back – who knows to what interval? Would a 5 years examination be acceptable in the presence of a trail of DA Maintenance by a DCP?  

 

If I were a Clinical Dental Technician I would feel I had been shafted and ignored – but since there are only 230 of this rare breed, I sense they were trampled by the rush. It seems they may be doomed to remain a niche business – but good luck to them for they are a light of success in many cases.

 

But in a fine example of joined up Government there remains the lack of freedom to prescribe simple analgesic drugs for placement in the mouth – how stupid can they be? If ever the GDC missed a trick of leverage, it must be here. Still I am sure it is high on the MHRA’s agenda.  Yeah, right.

DA is a bit like all the hype about 4G mobiles – it would be nice if they got 3G working everywhere first.  The OFT and GDC “selling” DA as “the next big thing” seems to have a whiff of snake oil about it if you ask me – and I work closely with a hygienist so declare an interest.

On the other hand, that occasional comprehensive examination by a dentist will now become a full works task – full charting, full mouth photographs, appropriate radiographs, TMD and parafunctional evaluation, aesthetic discussions, orthodontic review – you get the idea. 

Every Challenge is really an Opportunity

Maybe suddenly the periodic dental examination is actually a marketing opportunity to add value instead of down selling a simple “check up” [Don’t you HATE that phrase anyway ?]

But for the 6500 odd practices who employ DHs and DTs, little will change. In house protocols WILL change but surely this will be to the benefit of all involved. Patient care will become better for being seamless. Surely even the BDA can see that?

Will DCPs be rushing out to start their own practices – well not without substantial access to the capital funds required. And I cannot see HMG suddenly discovering a pot of money in the next 10 years.

Will DCPs now be able to obtain a Provider Number from the NHS Commissioning Boards? – well, there is an interesting prospect.  Because many might feel that this OFT driven change by the GDC is barely worth the paper it is written on without such a possibility.

Will the long term NHS Access strategy be to allow access to employed DCPs in enhanced outreach?  While many would see that as a very positive step [just thinking of the Scottish model] that raises issues of employment such as access to the NHS pension.

Perhaps what is clear is that there remains a conflict between the many thousands of Practice Owners and how they lead their teams, and a very small cadre of Dental Academics [4] who, seeming to have the ear of the CDO and his DH advisers, are re-writing the agenda for the provision of State funded dentistry.

It’s simple guys and girls:  Stop panicking like headless chickens and take a chill pill.  This “DA” seismic shift is fantastic news but not in the way the Government would like it to be.

The market is no sensibly estimated even by the OFT at £7.2B, and Private Practice is now £3.88B and rising. [Why the OFT excluded the ‘cosmetic element ‘ of £1.47B remains a political mystery – I don’t think so!] [5]

The Business of Dentistry needs DA to develop proper dentistry in high investment, high technology ultra professional Private Practice while the Government and its academic luvvies merely fans the flames of Rome-like “access” while living the NHS Big Lie of “Problem, what problem?”

 

 

Private practice needs DHs and DT more than the Government will pay them, and so exactly how will DA help Government policy? Well, it won’t and by the time the next Government start installing the next contract, dentistry will be up and away and the NHS offering will be sidelined to a minority social backstop.

 

I put it to my assembled colleagues: in the classic event driven by The Law of Unexpected Consequences,  Direct Access alongside the New Contract   will be  the death knell for Government management of NHS Dentistry because Private Dentistry will make better use of the work force and skill mix , more efficiently  and more  quickly than anything the DH can achieve. And it will pay better.

 

Finally we will have a core service indeed from the DH.

 

It is perhaps a shame that the apple is rotten.

 

[1] http://www.bda.org/news-centre/press-releases/41760-direct-access-decision-misguided-says-bda.aspx

[2] http://www.oft.gov.uk/shared_oft/market-studies/Dentistry/OFT1414.pdf

[3] http://www.gdc-uk.org/Newsandpublications/viewfromthechair/Documents/Evidence%20based%20policy%20Feb%202013%20Final.pdf

[4]  The OFT has had detailed discussions with a number of academic experts from dental  schools in England and Scotland, including Manchester, King’s College London, Leeds, Newcastle, Kent, Surrey and Sussex Deanery and Glasgow. The consensus among these experts  is that direct access can be implemented without compromise to patient safety and is necessary in order to make dental provision more efficient, effective and flexible for the patient, with benefits to be gained for the profession as a whole

[5] From the OFT Report 2012 - 'Dentistry UK Market Report 2011', Laing and Buisson, page 4.
The estimate that the dentistry market is valued at an estimated £5.73 billion a year is for 2009-10 and does not include cosmetic dentistry. The value of the dentistry market including cosmetic dentistry was estimated as £7.2 billion in 2010 according to 'The UK Dentistry Market Development' Market and Business Development (2010)

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Comments 3

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Anthony Kilcoyne on Tuesday, 02 April 2013 22:39
Ta Da - Direct Access actually equals Wider Access!

There are still issues to be resolved for Direct Access, which is really Wider Access for some DCP groups limited to their Scope (range of duties) that they are allowed to do.

Given they still can't prescribe simple LA or even Rads despite having done competency courses for these, is actually down to the English DH getting the change in name wrong when writing new laws in 2005, thus PCDs weren't changed to DCPs when put before Parliament and suddenly many were put back 10 years whilst clumsy temporary fixes are attempted like Patient Group Directives.

So will the English DH try to use DA/WA for it's own advantage?

Of course it will, but maybe like this Blog observes, their organisational and planning is so short-term and useless for patients, they tend to put things back 10 years rather than forward 10 years, such as UDAs - until there is a big centralised change there, we are again dependent upon Private Dental Practice in England to make any true Progress for all of Dentistry and thus the Public.

What we need is WIDER ACCESS to more Time, more Quality and most importantly, more CARE for patients - surely Mid-Staffordshire and the Francis report has taught us that is unlikely to happen in the (limited in more ways than one!) NHS System from the Top-Down without a massive culture change that is TRULY patient-centred and delivered by DENTIST led Teams who Widen Access for all the Public Nationally !

It's time for our Dental Profession to LEAD the way, show how it's done well, so it's not just 'Access' to anything to tot-up Target number volumes to satisfy Politicians' and Bureaucrats' selfish needs, but Access to 'Comprehensive Care' delivered by 'Comprehensive Teams' which on a National Scale, those running the NHS competitively may realise this is a mistake, because it needs to be run SYNERGISTICALLY from it's inadequate limited budget as an important safety-net core service.

That is The Big Truth which the BDA, BSDHT, BADN, DLA, BACDT etc, etc. need to work towards AND promote as a very Public Vision of what is desirable for all too!

Now THAT would be fully informed and fully VALID consent for the Public - it's time to be Visionary Very Loudly indeed!

Yours Progressively,

Tony.

0
There are still issues to be resolved for Direct Access, which is really [i]Wider Access[/i] for some DCP groups limited to their Scope (range of duties) that they are allowed to do. Given they still can't prescribe simple LA or even Rads despite having done competency courses for these, is actually down to the English DH getting the change in name wrong when writing new laws in 2005, thus PCDs weren't changed to DCPs when put before Parliament and suddenly many were put back 10 years whilst clumsy temporary fixes are attempted like Patient Group Directives. So will the English DH try to use DA/WA for it's own advantage? Of course it will, but maybe like this Blog observes, their organisational and planning is so short-term and useless for patients, they tend to put things back 10 years rather than forward 10 years, such as UDAs - until there is a big centralised change there, we are again dependent upon Private Dental Practice in England to make any true Progress for all of Dentistry and thus the Public. What we need is WIDER ACCESS to more Time, more Quality and most importantly, more CARE for patients - surely Mid-Staffordshire and the Francis report has taught us that is unlikely to happen in the (limited in more ways than one!) NHS System from the Top-Down without a massive culture change that is TRULY patient-centred and delivered by DENTIST led Teams who Widen Access for all the Public Nationally ! It's time for our Dental Profession to LEAD the way, show how it's done well, so it's not just 'Access' to anything to tot-up Target number volumes to satisfy Politicians' and Bureaucrats' selfish needs, but Access to 'Comprehensive Care' delivered by 'Comprehensive Teams' which on a National Scale, those running the NHS [i]competitively[/i] may realise this is a mistake, because it needs to be run [i]SYNERGISTICALLY[/i] from it's inadequate limited budget as an important safety-net core service. That is [b]The Big Truth[/b] which the BDA, BSDHT, BADN, DLA, BACDT etc, etc. need to work towards AND promote as a very Public Vision of what is desirable for all too! Now THAT would be fully informed and fully VALID consent for the Public - it's time to be Visionary Very Loudly indeed! Yours Progressively, Tony.
Chas Lister on Tuesday, 02 April 2013 23:42
So where next

interesting points AK with which one can but agree surely, and of course I am conscious pf your official standing too.

What about my thoughts that now we need a private practice model for sociallly deprived dental care?

http://www.gdpuk.com/forum/gdpuk-forum/let-s-start-the-countdown-13962#p145873

0
interesting points AK with which one can but agree surely, and of course I am conscious pf your official standing too. What about my thoughts that now we need a private practice model for sociallly deprived dental care? http://www.gdpuk.com/forum/gdpuk-forum/let-s-start-the-countdown-13962#p145873
Anthony Kilcoyne on Wednesday, 03 April 2013 00:48
Socially deprived Pro Bono?

Whilst this SHOULD be the job of the NHS system, like a lot of Charities are finding in a recession, HMG simply cannot cope and depends upon the Goodwill of others to fill the widening gaps, so to speak.

It's no different for Dentistry either - of course limited NHS Dental funding should be used for those most in need mostly, but there is a VAST public education campaign needed which as a Dental Professionals, we should take the LEAD in and yes that includes doing a certain % Pro Bono too !

Synergy knows no limits in the Public interest overall - start with that mindset and then suddenly one can start planning 'ideally' longer-term, instead of the multi-failed short-termisms imposed upon Dentistry by selfish, ignorant or just incompetent bodies

Yours also Proactively,

Tony.

0
Whilst this SHOULD be the job of the NHS system, like a lot of Charities are finding in a recession, HMG simply cannot cope and depends upon the Goodwill of others to fill the widening gaps, so to speak. It's no different for Dentistry either - of course limited NHS Dental funding should be used for those most in need mostly, but there is a VAST public education campaign needed which as a Dental Professionals, we should take the LEAD in and yes that includes doing a certain % Pro Bono too ! Synergy knows no limits in the Public interest overall - start with that mindset and then suddenly one can start planning 'ideally' longer-term, instead of the multi-failed short-termisms imposed upon Dentistry by selfish, ignorant or just incompetent bodies :( Yours also Proactively, Tony.

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