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

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