Transcript The organisation of NHS dentistry

The organisation of dentistry in
the UK
Dr D White
PH & Epidemiology - October 2006
Outline

Historical perspective

The role of the General Dental Council

The dental team

Dentistry within the NHS
PH & Epidemiology - October 2006
Dentistry within the NHS (1948)

Tripartite system
 Hospitals
 general / dental
 Local Authorities
 school dentists
 General Dental Practitioners
 independent contractors
PH & Epidemiology - October 2006
Changes since 1948

NHS reorganisations
 1974, 1982, 1990
 Little effect on GDS
PH & Epidemiology - October 2006
NHS dental services following
1990 reorganisation

Purchasers
 Local
commissioning
authorities (DHA)
 (GMP fundholders)

Providers
 Hospital Trusts
 Community Trusts
General Dental Practitioners
PH & Epidemiology - October 2006
General Dental Council
Regulatory Body for Dentistry
 Compulsory registration for dentists,
therapists and hygienists
 Continuing Professional Development
 Complaints
 Quality Assurance of Dental Education
 Publications – consent, confidentiality etc

PH & Epidemiology - October 2006
The Dental Team
Dentist
 Dental Care Professionals (DCPs)
 Nurse
 Hygienist
 Therapist
 Technician

PH & Epidemiology - October 2006
Dental Hygienist
Diploma – 2 year course
 Work to dentist’s prescription
 Clean, scale & polish teeth
 Apply prophylactic materials
 Administer local anaesthetic

PH & Epidemiology - October 2006
Dental Therapist








2 – 3 year course (may be BSc)
Work to dentist’s prescription
Extract deciduous teeth
Simple dental fillings
Clean, scale & polish teeth
Apply prophylactic materials
Administer local anaesthetic
Take X-rays
PH & Epidemiology - October 2006
Register of DCPs
Opened 31st July 2006
 2 year transitional arrangements
 Dental nurses & dental technicians
 Existing qualifications OR
 Experience & demonstrate competency in 6
areas

PH & Epidemiology - October 2006
Oral health care in the UK
(Daly et al 2002)
Public Sector provision (£1674 million/yr)
 General Dental Services (GDS)
 Community Dental Services (CDS)
 Hospital Dental Services (HDS)
 Personal Dental Services (PDS)
 Dental Defence Agency (DDA)
 Private Sector provision (£926 million/yr)

PH & Epidemiology - October 2006
NHS dentistry facts and figures





21,082 dentists (GDS & PDS) - Sept 2005
GDS
 14,377 principals
 1,111 assistants
 375 VDPs
PDS
 6,809 dentists
 303 VDPs
18.3 million registered adult patients (45%)
7.3 million registered children (62%)
PH & Epidemiology - October 2006
NHS Services in Medicine and
Dentistry
SPCDS (CDS,
Hospital
PDC, DAC)
5%
5%
GMP
40%
Hospital
55%
GDP
90%
CMP
5%
Medicine
Dentistry
PH & Epidemiology - October 2006
General Dental Services
National contract covering patient
registration, dentist remuneration & other
procedures
 Dentists independent contractors
 New contract in 1990 - registration and
emergency ‘out of hours’ provision
 New contract April 2006 - Units of Dental
Activity (UDAs)

PH & Epidemiology - October 2006
Working in the GDS
Vocational Training
 Principals, Associates and Assistants
 Contract with Primary Care Trust (PCT)
 Monitoring through Dental Reference
Service

PH & Epidemiology - October 2006
Community Dental Service
Established in 1974 (from local authority)
 Salaried service - terms and conditions
negotiated nationally
 1700 dentists (1999)
 Contractual arrangements with PCT and
Consultant in Dental Public Health

PH & Epidemiology - October 2006
The role of the CDS
Treatment of special needs groups
 Specialist referral service (GA, ortho)
 ‘safety net service’
 Screening
 Epidemiology
 Oral Health Promotion

PH & Epidemiology - October 2006
Hospital Dental Service
Salaried service
 2500 dentally qualified personnel
 Provision of specialist dental care
 Training of undergraduates and
postgraduates
 Consultants have parity with medical
colleagues
 Contractual arrangements with PCT

PH & Epidemiology - October 2006
Personal Dental Services
Commenced 1998
 New ways of providing dental care
 Pilot sites
 Three waves
 Dental Access Centres (DACs)
 Pilot schemes ended when new GDS
contract implemented

PH & Epidemiology - October 2006
Recommended reading
Essential Dental Public Health. Daly et al.
Chapter 19
 www.dpb.nhs.uk
 www.gdc-uk.org/

PH & Epidemiology - October 2006