• This year sees more innovative events than ever before. They range from screenings of Charlie Chaplin’s ‘The Dentist’ to a marathon to raise awareness of oral health.

• The new World Oral Health Day 2015 poster customisation app will help support participating organisations.

Geneva, 10 March 2015 - As World Oral Health Day 2015 approaches countries worldwide are preparing to celebrate in their own way. The theme is ‘Smile for life’.

Planned activities in 2015 include: a media campaign on local radio stations and free dental check-ups for over 500 children in Senegal; a selfie contest under the theme ‘Smile for life’ in Spain; free oral health assessments and fluoride treatments for all children attending a camp in Liberia; and an attempt to achieve a world record for the most amount of voluntary dentistry done in one day in Australia.

The challenge is for National Dental Associations, Student Dental Associations and World Oral Health Day Partners to match or outdo last year’s vast array of activities, which included an attempt on the World Record for the number of people brushing their teeth simultaneously.

Also this year, a new application provides participants with the means of customizing their World Oral Health Day campaign poster with pictures and other features adapted to their local, regional or national needs.

‘It’s wonderful to see the enthusiasm of so many different groups in the pursuit of raising oral health awareness within their communities,” said FDI President Dr Tin Chun Wong. “World Oral Health Day 2015 is set to be bigger and better than ever before, helping to spread the message of a ‘Smile for life’ across the globe.”

To find out if there is an activity near you or to get involved yourself, visit the World Oral Health Day website, which offers the latest news and a range of downloadable material to help celebrate a ‘Smile for Life’ on 20 March 2015.

WOHD is celebrated throughout the world on 20 March each year with a wide range of awareness-raising activities organised by dentists, dental students and National Dental Associations (NDAs). It offers the dental and oral health community a platform to take action and help reduce the global disease burden of oral disease.

Ninety per cent of the world’s population will suffer from oral diseases in their lifetime and many of them can be avoided with increased governmental, health association and society support and funding for prevention, detection and treatment programmes.

About FDI

FDI World Dental Federation serves as the principal representative body for more than 1 million dentists worldwide, developing health policy and continuing education programmes, speaking as a unified voice for dentistry in international advocacy, and supporting member associations in global oral health promotion activities. FDI is in official relations with the World Health Organization (WHO) and is a member of the World Health Professionals Alliance (WHPA).

For more information, visit: www.fdiworldental.org

About World Oral Health Day

World Oral Health Day is celebrated every year on 20th March. The theme of World Oral Health Day 2015 is ‘Smile for life’. It reflects the major contribution oral health makes to our lives. Around the world, FDI member dental associations, schools, companies and other groups will celebrate the day with events organized under this single, unifying and simple message.

For more information, visit: www.worldoralhealthday.org

World Oral Health Day 2015 partners

LISTERINE® brand Mouthwash, part of the Johnson & Johnson Family of Consumer Companies

As the world’s number one daily mouth rinse, LISTERINE® Mouthwash has been used by more than one billion people in more than 85 countries. Professional dental organizations around the world have awarded LISTERINE® Mouthwash with their seals of acceptance.

LISTERINE® is distributed by Johnson & Johnson Healthcare Products Division of McNEIL-PPC, Inc., a part of the Johnson & Johnson Family of Consumer Companies, which is the world’s sixth-largest consumer health company and is a segment of Johnson & Johnson, the world’s most comprehensive and broadly based manufacturer of health care products.

Unilever 

Unilever Oral Care is a leading global manufacturer of oral care products, including toothpaste, toothbrushes and mouthwash, represented by brands including Signal, Pepsodent, Close Up, Mentadent, Aim, P/S and Zhong Hua. Unilever recognizes that good oral health and the sense of well-being and confidence it brings, is a vital element to making people look good, feel good and get more out of life and that small every day actions, such as twice daily brushing with a fluoride toothpaste, add up to make a big difference for the world. Through its science, products, partnerships and international network, Unilever Oral Care is privileged with the power to make a sustainable and measurable improvement to oral health around the world.

Henry Schein

Henry Schein, Inc. is the world's largest provider of health care products and services to office-based dental, animal health and medical practitioners.  A Fortune 500®{C}[1]{C} Company and a member of the NASDAQ 100®{C}[2]{C} Index (NASDAQ Ticker: HSIC), Henry Schein employs more than 17,500 Team Schein Members and serves more than 800,000 customers. Headquartered in Melville, N.Y., Henry Schein has operations or affiliates in 28 countries. Through Henry Schein Cares, the Company’s global corporate social responsibility program, Henry Schein helps expand access to health care for underserved and at-risk communities around the world. For more information, visit the Henry Schein Web site at www.henryschein.com.

Wrigley Oral Healthcare Program (WOHP)

WOHP partners with dental professionals worldwide, helping them improve their patients’ oral health through one extra simple and enjoyable step in their daily routine: chewing sugarfree gum after eating and drinking on-the-go. WOHP supports independent clinical research into the benefits of chewing gum, including saliva stimulation, plaque acid neutralization and tooth strengthening. For more information, visit: www.wrigleyoralcare.com

The Chancellor of the Exchequer, George Osborne, delivered the last Budget of this parliament today. Jon Drysdale highlights items of interest to dentists.

Tax cuts

Big tax cuts for income tax payers and help for savers through greater flexibility on ISAs. With the majority of dentists being higher rate tax payers, this is positive news.

Simplification of the tax system was announced with the annual tax return removed - more details to follow. The fuel duty increase will be frozen again.

The personal tax-free allowance will be raised to £11,000 in 2017. The higher rate tax threshold, which affects most dentists, will rise to £43,300 in 2017/18.

Pensions hit

On a more negative front, the Lifetime Allowance on pensions is to be reduced to £1m from next year. This is likely to significantly impact dentists with NHS pensions. It remains to be seen what transitional protection will be offered to those breaching the new reduced allowance. The change is potentially going to encourage dentists to draw their NHS pension earlier than planned to avoid a Lifetime Allowance charge. 

Savings

Four major new steps on savings were announced:

1. Greater access to pension annuities. 

2. A more flexible ISA with annual savings limit increasing to £15,240 (2014/15) and allowing withdrawals and re-contributions in the same year without losing tax-free allowance.

3. 'Help to Buy' ISA for first time buyers with a 25% top-up – effectively tax relief on ISAs.

4. First £1,000 of interest on savings income to be tax-free.

Business

Corporation tax will be cut to 20% in two weeks time, with small business rates also to be cut. Class 2 National Insurance to be abolished.

Comment

Jon Drysdale, an independent financial adviser from PFM Dental, commented: “While there are positives in this budget for dentists the most worrying single announcement today is the further cut to the Lifetime Pension allowance to £1m. Many dentists are already subject to a charge as the allowance has fallen in recent years. Hopefully, some transitional protection will be available and we will be following developments on this closely. The need for specialist advice in this area has never been greater." 

PFM Dental offers independent financial advice exclusively to dentists. For more information visit www.pfmdental.co.uk

Bringing the curtain down on dentistry for 2014, Nigel Jones shares with readers some of the more noteworthy news from this year in relation to the New Contract and private dentistry.

Nigel Jones is part of the change support team for Practice Plan. With 24 years’ experience within the dental industry, he has guided many dentists through the 2006 NHS contract and continues to do so today; contact him for further advice and support on This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.practiceplan.co.uk/nhs.

With the knowledge that the New Contract pilots were to continue into 2015, this year the dental profession were keeping a keen eye out to see how they would progress.  In addition, there was a renewed interest in whether private dentistry might, for some, be a viable way forwards.

It was in February at the Dentistry Show that the first significant discussion of the year took place on the issue of the New Contract. This dialogue clarified that Professor Steele was committed to taking all the time needed to review the data available to produce an effective system that would focus on prevention rather than cure.

Also speaking at the event was oral epidemiologist Liz Kay, who emphasised the need to take into consideration the full oral health picture in the UK, not just to create a contract based upon the needs that could be ascertained from average figures. She asked delegates to consider the realities of dental practice where, for example, the majority of Baby Boomers – who grew up without preventive advice – would need dental treatment in the coming years.

In March it was reported that, for the first time in eight years, the profit level of the average private dental practice was almost the same as the average NHS dental practice, based on the latest benchmarking statistics from the National Association of Specialist Dental Accountants and Lawyers.

Figures showed that the average net profit in 2012/13 for a principal of a private practice was £124,086 compared to £125,958 for a principal of an NHS practice.

In April we also learned that after a difficult economic time, private dentistry is set to ‘bounce back’ and make the most of the opportunities offered by an industry currently valued to be worth £5.9bn every year, according to latest report into the UK dentistry market from LaingBuisson.

That same month, Lloyds Bank Commercial Banking Healthcare Confidence Index suggested that uncertainty over NHS dentistry was affecting dentists’ choices. It reported that 80% of those questioned were apprehensive that the NHS would provide adequate financial support. In addition, it was revealed that 69% of dentists are planning to grow their business to help overcome any possible financial pressures brought on by the NHS contract.

Commenting on the results, Ian Crompton, Head of Healthcare Banking Services, Lloyds Bank Commercial Banking, stated: ‘The wider economic uplift has boosted dentistry morale, with dentists again the most confident profession in the short-term, and it is interesting that there has been a noticeable shift in the number of dentists expecting private practice to again become more profitable than NHS.’

The summer months

At the 2014 Conference of Local Dental Committees in Manchester in June, John Milne, chair of the BDA’s GDPC, expressed disappointment at the slow progress being made with designing the prototypes for the New Contract and suggested that the government needed to get a move on.

In July, at the Westminster Health Forum seminar on oral health inequalities, dentistry commissioning, regulation, and the dental contract reform dentist Sabrena Kara spoke about her practice’s experience of taking part in the pilots. She offered a positive view on time management, which then allowed her to focus on delivering more complex dentistry to patients.

August saw a story in The Telegraph reporting: ‘Patients are having to travel up to 40 miles to see a dentist or being forced into private care because they struggling to find treatment locally, a consumer watchdog has warned.

‘Healthwatch England said that patients are experiencing ''increasing frustration'' about NHS dentistry as patients struggle to know where to turn.

‘Some are travelling up to 40 miles to find somewhere that will provide free care while others are so discouraged by their attempts to find a health service dentist that they end up paying for private treatment, it said.’

Dr Cockcroft responded: ‘Our figures tell us that 93% of people who tried to get an NHS dental appointment in the past two years were successful. Of the 6.5% who tried to get an NHS dental appointment at a practice that they had never attended before, 76% were successful.’

Drawing to a close

In October, the BDA’s GDPC came together to discuss the New Contract, welcoming the fact that Alternative Contract Reform (ACR) input had become part of the debate on contractual change. The case for change was described as ‘irresistible’ by the chair, Dr Milne, who continued: ‘We have an historic opportunity here to turn the page on activity targets and put prevention at the heart of dentistry. And the GDPC is determined to get it right on behalf of the profession.’

 Looking to 2015

Despite some disappointment surrounding the slow implementation of the New Contract, 2014 still managed to deliver interesting signposts for dentists looking to the future. Given the well-publicised financial pressure on the NHS, the Government's imperative will be to find a form of contract that will extract the best value it can from NHS dentists.  Come May 2015 and the results of the general election, the dentistry ball may well be up in the air once again. Whatever the outcome, this will mark a new beginning for dentists choosing between NHS and private dentistry to fulfil their commitment to looking after their patients while running a sustainable business.

Practice Plan considers what the current dental contract has to offer and takes a look at what changes could be incorporated into NHS dentistry when the revised contract is fully rolled out.

In 2006 to much fanfare – on the Government’s side at least – a new NHS dental contract came into force. At the time some dentists chose to leave the NHS altogether preferring the private route, some created a mixed practice but the majority stayed put, believing in the provision of dentistry to those in need.

Over the following years, again, some have changed the way they practise; but still a large number have continued to operate within the parameters of the contract while others have joined the NHS. Statistics released by the Health and Social Care Information Centre tell us that 23,723 dentists performed NHS activity during 2013-14. This is an increase of 522 (2.2%) on 2012-13, and 3,563 (17.7%) more than 2006-07.

With a revised contract on the horizon, what does the 2006 contract offer and what might we reasonably expect the next one to deliver?

John Milne Chair of BDA GDPC once said: ‘How can a system improve oral health, deliver prevention, continuing care and advanced treatment, whilst paying dentists adequately, fairly, and provide an environment where all this can be achieved with minimal perverse incentives from any direction to enable the patient, the government and the profession to have confidence for the future?’

Remuneration

As we know all too well, the contract to which the majority of NHS dentists are working operates on annually targeted UDAs (the exception being those on the piloting scheme).  This has, of course, raised some financial issues; a popular view is that dentists have not been receiving fair remuneration for their work in more extensive cases. It should be noted, however, that, committed as they are to patient care, the vast majority of dentists who have stayed in the NHS have worked hard to provide a quality service.

The contract currently being piloted shuns UDAs and instead a capitation system is being tested. Essentially, capitation provides payment according to an agreed number of patients seen during a specified period of time. Three are being piloted:

• Type 1 – guaranteed remuneration for guaranteed NHS commitment

• Type 2 – weighted capitation payments applied within tolerance of contract value with capitation payment covering all care

• Type 3 – weighted capitation model applied within tolerance of contract value with capitation payment covering only routine care and remaining contract value attributed to complex care guaranteed.

Weightings are applied to the registered population, which aim to reflect the workload involved in meeting patient needs. In the report ‘Dental Contract Reform Programme. Early Findings: Opportunity to give feedback’, the following example for a hypothetical practice treating 100 patients was provided:

• Twenty high-need patients: £10 per patient = £200

• Fifty low-need patients: £5 per patient = £250

• Thirty medium-need patients: £7.50 per patient = £225.

This provides a weighted capitation of £675.

With these pilots ongoing, which of these three options are achieving success is unknown, but it seems fair to suggest capitation is likely to feature in some form. 

It would be remiss while on the subject of finances to move on without considering the forthcoming contract’s affordability for the government. Contact reform offers an interesting conundrum; you might achieve happy patients and dentists but realistically only at a cost that would be unacceptable in a wider roll-out. For example, the new approach involving a preventive pathway takes more time and means longer appointments than before, which is why patients tend to like it. Within the pilots, the dentists are happy as they have had their income ring-fenced so they can essentially take as long as they want without incurring any financial penalty. In addition, that all means that access has dropped and fewer patients are being seen which, given that has been a priority for successive governments, won’t be deemed acceptable. There seem to be three possible solutions to this – making more money available (which, let’s face it, is never going to happen in the current economic climate), finding a way that forces individual dentists to improve access for the same money or to accept lower access per dentist but pay individual dentists less.

Quality

There’s little to be written about the 2006 contract and quality treatment that you haven’t already heard or read many times over. Suffice to say, it constrains care to providing treatment to achieve oral fitness and little else; this is a system that does not easily lend itself offering a high level of care and NHS dentists remain the unsung heroes for achieving high quality results. Considered by many as an incentivising scheme gone horribly wrong, we all look to the future with great expectations.

The (hopefully) forthcoming contract aims to deliver high-quality, prevention-based care based upon three indicators:

1. Patient safety

2. Clinical effectiveness

3. Patient experience.

This is where the much talked about Primary Care Clinical pathway approach comes into play. The clinical pathway begins with a comprehensive oral health assessment, recording information on caries, periodontal disease, tooth wear and the soft tissues. Needs and risk are then assessed based upon both clinical information and that obtained from the patient. A preventive plan is then created and shared with the patient and dental team. Lastly, a review date is set according to risk and NICE guidelines.

Advanced care pathways are also being piloted in endodontics, periodontal care, indirect restorations and metal-based partial dentures.

All of this is being supported with the use of software provided by one of three software companies.

Thus far, overall the concept has been considered to have a sound basis but, again, things are still being ironed out so while the future looks to be preventive based there are no guarantees.

Registration

Under the 2006 contact, formal registration with a dental practice, which had been introduced in 1990, came to an end.  In essence, nowadays no-one in England and Wales is registered on the NHS with a particular practice although, in truth, this is not on many patients’ radar. However, access appears to have been a problem for some patients, with pre-pilot figures indicating that 24,292 patients received emergency dental treatment in hospital casualty departments in 2009/10, compared to approximately 17,400 in 2000/2001. These statistics certainly do suggest that fewer people were getting the dental treatment they needed between 2000 and 2010.  
 

The future contract, meanwhile, promises provide a formal system of patient registration, ensuring patients will receive ongoing care as and when clinically needed. We don’t know much more than that, but it sounds like a good plan to improve access and long-term oral health.

Tentative hopes…

So here we are; the majority of practices are still working within the confines of the 2006 contract and the minority piloting the next contract. The possibilities are tantalising but there is still so much that we don’t know.  When will the pilots end? How will the general election affect NHS dentistry?  And last, but by no means least, how will the government, whatever their affiliation, work within the confines of national finance to deliver what is being promised? We have hope that the resources available can be used to best effect.

Practice Plan is the UK’s number one provider of practice-branded dental plans. They have been supporting dentists with NHS conversions since for over 20 years, helping them to evaluate their options and, for those who decide to make the change, guide them through a safe and successful transition to private practice. So, if you’re thinking about your future and would like some expert advice you can trust, then call 01691 684120 or visit www.practiceplan.co.uk/nhs.