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  • When the NHS was formed in 1948, it had a tripartite structure with dental services in each part. Hospital dentists specialised in dental surgery or orthodontics (straightening), and were graded in the same way as hospital medical staff. Some worked in dental departments of general hospitals and others in specialist dental hospitals. The School Dental Service was established under the 1944 Education Act. These dentists were employed by Local Authorities. Principal School Dental Officer organised the services and their remit was to provide free dental inspection and treatment for all children in stated maintained schools, and also provided care for the dental health of the mothers and children of pre-school age. Dentists entering the new general dental service scheme had resisted successfully government attempts to house them in health centres as salaried staff. The result was that general dental practitioners were given independent contracts and remunerated by ‘item of service provided. Flood gates opened and enormous amount of dental care provided. During first five months of scheme, 4.2 million teeth filled, 4.5 million extracted and 33.4 million sets of dentures were made!
  • NHS dental services now are provided by hospital and community trusts. These services are purchased or commissioned by the District Health Authority. Contracts are made between purchasers and providers as to number of patients to be seen, type of treatments etc. Although GMP fundholders are purchasers too, do not purchase dental services. General Dental Practitioners are outside this arrangement. Administrative payment details are dealt with by the DHA which has now merged with the FHSA (previously the FPC). Withdrawal of dentists from NHS has led to some Health Authorities employing salaried dentists to enable residents to access national heath service care.
  • /ecourse/DPH/docs ...

    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>