The next steps to modernise and reform NHS dentistry were outlined by Health Minister Rosie Winterton today. The measures kick start an important new phase of the Government's reform programme by promoting good oral health, setting out a new dental charges system and outlining a new NHS contract for dentists.
Today's proposals will build on the current phase of the modernisation agenda, which included recruiting the equivalent to an extra 1000 NHS dentists, increasing undergraduate training places and devolving funding to local Primary Care Trusts.
A new dental charges system will scrap the outmoded and complex "fee scale" system where dentists have to claim separately for every single item of treatment they carry out.
This means that dental patients will know exactly how much they are being charged before they receive their treatment. The new system groups all dental treatment into three easy to understand bands which will make charges fairer and less confusing for patients, and less bureaucratic for dentists to administer.
The new dental charging system will be:
-- fairer - the maximum cost of NHS dental treatment would be reduced by more than half and existing exemptions, including children under 18 and those on income related benefits will be maintained. These exemptions cover 25 per cent of all adult treatments provided by the NHS
-- simpler - moving from 400 individual charges to three simple price bands
-- clearer - so that patients know how much they are being charged and what treatment they will receive.
Outlined in a consultation paper the illustrative payment bands are:
Band 1 - this covers preventative dental work, such as scaling and polishing and the provision of oral health advice ?15.00
Band 2 - this covers simple treatment, for example fillings and extractions ?41.00
Band 3 - this covers complex treatment, such as bridgework, crowns, or dentures ?183.00
Under this new scheme, patients will make one single payment for their course of NHS treatment. For example, a patient requiring a filling would pay a single Band 2 payment which would cover both the initial examination and the filling.
The traditional basic 'check up' will be replaced with a more comprehensive oral health assessment, which will include any necessary x-rays, scale and polish, and oral health advice. This reflects NHS dentistry's shift away from invasive treatment to prevention of dental disease through patient education.
Patients currently exempt from paying dental costs, such as children, expectant and nursing mothers, and those on income related benefits, will continue to receive free dental care.
The new dental charges system reflects recent guidance from the National Institute for Clinical Excellence (NICE) which advises that patients be recalled between three and eighteen months depending on their clinical need - as opposed to the traditional six monthly recall. For a large majority of the population a six-monthly 'check-up' is unnecessary.
In addition, Rosie Winterton outlined new contractual arrangements for dentists which will come into effect in April 2006. The new contract will encourage the promotion of oral health and remove dentists from the 'drill and fill' treadmill by paying them for the overall service they provide to a patient, rather than for each of the individual treatments they carry out. The contract will also ensure dentists comply with the NICE guidance on recall times.
Rosie Winterton said:
"Many people complain that they don't understand their bills, and are confused over what is NHS and what is private treatment. The new dental charging system will enable dentists to give a simple answer to patients' questions 'what is my NHS treatment going to cost?' and 'what treatment will I get for the money?' The new system is fairer for all patients, those with low treatment needs will attend less often, and patients with high treatment needs should find their NHS dental treatment cheaper.
"The new system is also good for dentists as it is less time consuming and complicated to administer. Dentists also told us they dislike the current system where they have to claim for every single item of treatment. This outdated way of working, introduced in the post war years to reward dentists to 'drill and fill', has contributed to dentists reducing their commitment to the NHS in recent years and we are working to reverse that.
"The new dental charges reflect the modernisation of NHS dentistry and will promote good oral health. Dentists will be paid for the overall service they provide rather than for each of the individual treatments they carry out. Oral health of both adults and children in England is better than ever and we need to reward dentists for undertaking preventative work.
"Those with poor oral health or from low income backgrounds are often discouraged from seeking dental treatment due to the prohibitive costs. These patients will benefit from more affordable treatment, as the proposed band 3 costs are less than the current ?384 maximum charge. Those currently exempt from paying dental charges - children, expectant and nursing mothers, or families receiving income related benefits - will remain exempt.
"The new scheme is part of our wider agenda to improve dentistry services. An extra ?368m is being invested in the service, 1,000 new dentists are on track to be recruited by October and the number of dental school undergraduate training places will be boosted by 25 per cent starting this year."
Harry Cayton, National Director for Patients and the Public, who led the review of the dental charging system, said:
"This is a clearer system that will make patients aware of exactly what they will pay towards treatment. Many patients leave the dentist surprised by what they have been asked to pay and have told us that they find the existing system confusing. By reducing dental charges from more than 400 separate charges to three simple paybands, the majority of people will pay the same or less than they currently do for treatment, and the price of the most expensive treatment will be halved.
"In 2003 an Office of Fair Trading report on dentistry highlighted that some dentists fail to fully explain the choices available between NHS and private care and the consequent cost implications. As the maximum possible charge for NHS treatment is currently ?384, patients charged over that are paying private fees."
The consultation is welcomed by consumer groups, who have voiced concerns about patients being 'stung' with large bills after treatment, unaware of the maximum charge for NHS treatment and oblivious to the possibility that they may be treated as private patients. It is also supported by dentists, who dislike the current bureaucratic system because they find it difficult to administer.
England's Chief Dental Officer, Professor Raman Bedi said;
"Dentists tell us the current system feels like a treadmill and is the main cause of dissatisfaction amongst dentists. It is regarded as being inefficient and leading to poorer quality services. We believe the new charging regime will simplify and clarify the way patients contribute towards the cost of the dental care they receive. We are also confident the new regime will reduce the complexity of charging and the administrative burden on dentists and will support good clinical practice."
Frances Blunden, principal policy adviser with Which? (formerly known as Consumer's Association) and member of the Working Group on dental charges, said:
"Patients have the right to know the likely cost of treatment before they sit in the dentist's chair. Today's announcement at last gives people something to smile about and is a new and fairer way of approaching dental charges on the NHS. The changes mean a better system for patients, a better system for dentists and will hopefully lead to a better future for NHS dentistry."
Jonathan Ellis, Policy Manager at Help the Aged, and member of the Working Group, said:
"Good oral health is a vital component of a healthy older age, yet uncertainty about how much individuals are expected to pay for their NHS dental care can be a cause of real worry to many older people, particularly those with more complex oral health care needs, such as the 40% of older people have full or partial dentures.
"These new proposals balance greater fairness and transparency in paying for NHS dental care while maintaining the safeguards that are designed to protect the poorest members of our community from high patient charges. They will be welcomed by many older people who require more complex treatment for high level needs who should find themselves paying less under the new system."
David Harker, Chief Executive, Citizens Advice and member of the Working Group, said:
"The new charging structure is a good start in breaking the link between high health needs and high charges. A Citizen's Advice Bureau survey we carried out in 2001 showed that nearly half (44%) of patients find their dental charges difficult to afford, rising to three-quarters (75%) amongst those charged over ?200, so we welcome the proposed reduction in the maximum charge from ?384 to ?183.00. This means that some of the patients who need the most extensive and costly dental treatment such as dentures, should benefit most from the reforms."
Related links
Consultation on the draft National Health Service (Dental Charges) Regulation 2006
Code of Practice on Consultation
1. The 12 week consultation on the draft regulations begins today and can be found on the DH website via the above link.
More information on written consultation practices is available in the Code of Practice on Consultation on the Cabinet Office website via the above link.
2. The Government asked a Patient Charges Working Group of representatives from the dental profession and consumer organisations to propose a more transparent charging system which would raise the same proportion of total expenditure as presently equal to about ?600m per annum. The findings of the group, led by Harry Cayton are to be published as part of the consultation document.
3. NHS patients currently pay 80 per cent of the item-of-service fee paid to the dentist up to a maximum per course of treatment, currently ?384. The remaining 20 per cent is subsidised by the Government. This system cannot continue when the new local commissioning arrangements are introduced in April 2006 as dentists will no longer be paid on a fee-per-item basis. The Health and Social Care (Community Health and Standards) Act 2003 provides for a new system of patient charging.
4. The following groups continue to qualify for free NHS dental treatment:
-- children under 18 years of age
-- students under 19 years of age and in full time education
-- expectant and nursing mothers
-- people, or their partners, who are getting income related benefits
-- hospital in-patients or outpatients or Community Dental Service patients
5. In June 2003 the Government published its response to the Office of Fair Trading (OFT) report on the private dentistry market in the UK. It accepted the report's recommendations in full and announced a Government Action Plan to implement them. More details are available on the Department of Trade and Industry website.
6. To achieve a clearer distinction between private and NHS dentistry the General Dental Council (GDC) now requires dentists to give full information on options for treatment and possible costs. To enforce standards we are giving the GDC wider powers to ensure the fitness of practice of dentists and introduce arrangements for the investigation and resolution of complaints about private dentistry. The Dentists Act 1984 (Amendment) Order 2004 will update the current legislation in various ways: modernising fitness to practise procedures, introducing a private complaints scheme, and safeguarding patients by extending regulation to other professions within dentistry.
7. The new General Dental Services contractual arrangements, which dentists themselves have asked for, will be introduced by April 2006. It will encourage the promotion of oral health and dentists will be paid for the overall service they provide rather than for each of the individual treatments they carry out.
8. The draft regulations on the new contractual arrangements, which Primary Care Trusts and dentists will need to follow, will be published in due course. Prior to publication we are sharing the key elements of these draft regulations with the profession, NHS management and other key stakeholders. The key elements include:
-- Monitoring and performance management arrangements in relation to weighted courses of treatment which are derived from the new dental charging system.
-- Provisions to support practice based clinical governance and quality assurance.
-- A clearer basis for patients to distinguish between NHS and private treatment options.
-- Compliance with guidelines from the National Institute for Clinical Excellence on recall intervals for patients.
-- Greater choice for patients in relation to treatment on referral.
-- Better information for patients through more detailed treatment plans including on referral.
-- Clear standards for the provision of NHS sedation services.
-- Requirements for monitoring the outcomes of orthodontic treatments.
9. Personal Dental Services (PDS) pilot contracts between PCTs and individual dental practices have shown that they carry benefits for patients and dentists alike. Dentists are already taking up this new way of working because it removes them from a treatment and paperwork treadmill and patients are benefiting from a more preventative approach and improved access. Over 6,000 dentists in 2,200 dental practices have now opted to work under the new arrangements, representing 30 per cent of all NHS dentists. From April next year, all dentists working in the NHS will be working under the new arrangements rolling out the benefits they bring to both dentists and patients.
For media enquiries only, please contact Anna Brosnan at the Department of Health press office on 020 7210 4984.
For general enquiries please contact Public Enquiries on 020 7210 4850
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