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A Fresh Start for NHS Dentists and Their Patients

Posted on: Monday, 27 March 2006, 12:00 CST

By BRIAN GIBBONS

Many people will be aware that a new dental contract will be in place on April 1, 2006. This contract will mean some of the biggest changes to NHS dentistry since 1948. The changes being brought about offer a fresh start for both dentists and patients. It sees us moving away from the current situation where NHS dentists are paid per item of service - the so-called fee per item treadmill. The new contract will see dentists receive monthly payments which are no longer directly related to the dentist's activity.

This contract allows NHS dentistry to move away from a 'one size fits all' approach to a high quality, flexible service tailored to patients' needs in terms of preventative services and reactive treatment.

One of the central aims of the reforms is to improve access to NHS dentistry and the Welsh Assembly Government is investing substantial additional resources into NHS dentistry from 2006-07. In fact total investment in NHS dentistry will amount to some pounds 118m from 2006-07.

Almost a year ago I announced pounds 5m to help with the introduction of Personal Dental Service (PDS) pilot schemes. These schemes are based on the new ways of working that the contract will introduce. They have been a major success in Wales and have proved popular with dentists and patients.

Almost 50% of dentists decided to move across to PDS pilot schemes ahead of the new contract and have already adopted the new ways of working.

The real results of the scheme can be seen in the number of NHS dental places that have been secured or created since its introduction. The figures speak for themselves - since May 2004, 179 schemes have been approved across Wales securing NHS dental care for 701,637 existing patients and creating 201,087 places for new patients.

Local Health Boards have a vital role to play in improving dental provision for their local population. Their new responsibilities for local dental services will allow them to develop services that meet the oral health needs in their area.

The new system also means that if a dentist leaves a practice the funding for their contract will be given back to the LHB. This gives LHBs guaranteed resources which are not affected by the decision of an individual dentist.

Many patients may be concerned about their dentist no longer providing NHS services after April 1. I'd like to reassure people that most NHS dentists will continue to provide NHS dental services after April 1. I am aware that a small number may choose to either change the amount of NHS dentistry they provide or to stop providing NHS dental services. If you find yourself in this position and you want to find an alternative dentist who provides NHS care, you should contact your LHB who will be able to help you find an alternative NHS dentist.

Under the new ways of working dentists will no longer need to register patients, but this will not prevent them from keeping lists of regular patients or providing ongoing treatment and care. Registration was introduced in 1990 as a way of measuring how much dentists should be paid for providing NHS dental services. This system is no longer relevant.

Under the old system, dentists received a payment for the number of patients registered with the practice. They were also responsible for providing out-of-hours care for patients registered with the practice.

From April 1, your LHB will be responsible for out-of-hours care and will commission services for the whole community. This will provide a central point of access for urgent and out-of-hours dental care.

You may also notice that the frequency of your appointments changes. This is because of guidelines introduced by the National Institute for Health and Clinical Excellence which recommend that patients should attend at intervals that reflect their oral health needs. People with good oral health may only need to attend once every 12 to 24 months though others with dental health problems may need to be seen more often.

There will also be a new, simpler three-standard charge system for NHS dental treatment. This will make it easier to know how much you may need to pay. The maximum charge for a complex course of treatment has been halved from pounds 354 to pounds 177. Most courses of treatment will cost pounds 12 or pounds 39. But you will still receive free NHS dental treatment if you meet the exemption criteria - if you are on low income, for example.

This is inevitably a time of uncertainty for patients as well as some in the dental profession, but there should be no doubt over the Assembly Government's commitment to NHS dentistry and to a modern and responsive dental service across the whole of Wales.

I want us to reach a position where everyone has access to NHS dental provision. We still have some work to do but I'm confident that the new contract will help to make this happen.: QUESTIONS AND ANSWERS:Q I'm in my early 50s and have been suffering from chronic knee pain for a couple of years. Although I get off to sleep easily at night I can wake several times with the pain, overheating and sweating at the same time. Is there a connection?

A This could indicate depleted, or dried up, kidney yin energy, which, in Chinese medicine, is the equivalent to body fluids.

This would affect the knee joints and the drying up of the synovial fluids.

The kidney meridian passes through the knee joints and can be accessed easily by using acupuncture points around the knees and stimulating your kidneys at the same time.

Kidney yin deficiency would also cause your restless sleep and overheating symptoms, often associated with the menopause.

Points on the kidney meridian would be used to nourish the yin and clear the heat.

Q I suffer from red, irritated eyes periodically. It seems to be associated with times of stress. Several professionals have concluded it is an allergy. Is there anything I can do to sooth them?

A In Chinese medicine the eyes are associated with the liver, and what you are experiencing is indicative of an imbalance in the liver energy.

The redness and the irritation are symptoms of heat which could be brought on by stress or anger.

The liver is responsible for ensuring the smooth flow of energy, including emotional flow, throughout the body. If this gets upset it can manifest in the eyes. It would be worth having a session of acupuncture to clear the heat and stagnation in the liver energy.

You could also use eyebright, chamomile, mint or thyme externally to bathe your eyes. Consult a herbalist for dilution and frequency.

Q I have unpredictable and alarming vertigo. I have been prescribed Betahistine but I would prefer to do something alternative to help myself.

A Vertigo, from an oriental standpoint, arises from deficient liver energy causing weakness in the gall bladder meridian. When working normally, this meridian is responsible for conducting enough inner strength to the brain to prevent dizziness.

By having a few sessions of acupuncture to invigorate and strengthen the liver and gall bladder energy, and by nourishing the liver blood to rise to the head, it could alleviate your concern about medication.

If you have a question for Jacqueline, e-mail madeleine. brindley@wme.co.uk

Source: Western Mail

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