PH & Epidemiology - October 2006 The organisation of dentistry in the UK Dr D White.

PH & Epidemiology - October 2006

The organisation of dentistry in the UK

Dr D WhiteDr D White


Outline

Historical perspectiveHistorical perspective

The role of the General Dental CouncilThe role of the General Dental Council

The dental teamThe dental team

Dentistry within the NHSDentistry within the NHS


Dentistry within the NHS (1948)

Tripartite system Tripartite system Hospitals Hospitals

general / dentalgeneral / dental Local AuthoritiesLocal Authorities

school dentists school dentists General Dental Practitioners General Dental Practitioners

independent contractorsindependent contractors


Changes since 1948

NHS reorganisationsNHS reorganisations 1974, 1982, 19901974, 1982, 1990 Little effect on GDSLittle effect on GDS


NHS dental services following 1990 reorganisation

PurchasersPurchasers Local Local

commissioning commissioning authorities (DHA)authorities (DHA)

(GMP fundholders)(GMP fundholders)

ProvidersProviders Hospital TrustsHospital Trusts Community TrustsCommunity Trusts

General Dental Practitioners


General Dental Council

Regulatory Body for DentistryRegulatory Body for Dentistry Compulsory registration for dentists, Compulsory registration for dentists,

therapists and hygieniststherapists and hygienists Continuing Professional DevelopmentContinuing Professional Development ComplaintsComplaints Quality Assurance of Dental EducationQuality Assurance of Dental Education Publications – consent, confidentiality etcPublications – consent, confidentiality etc


The Dental Team DentistDentist Dental Care Professionals (DCPs)Dental Care Professionals (DCPs)

NurseNurse HygienistHygienist TherapistTherapist TechnicianTechnician


Dental Hygienist

Diploma – 2 year courseDiploma – 2 year course Work to dentist’s prescriptionWork to dentist’s prescription Clean, scale & polish teethClean, scale & polish teeth Apply prophylactic materialsApply prophylactic materials Administer local anaestheticAdminister local anaesthetic


Dental Therapist 2 – 3 year course (may be BSc)2 – 3 year course (may be BSc) Work to dentist’s prescriptionWork to dentist’s prescription Extract deciduous teethExtract deciduous teeth Simple dental fillingsSimple dental fillings Clean, scale & polish teethClean, scale & polish teeth Apply prophylactic materialsApply prophylactic materials Administer local anaestheticAdminister local anaesthetic Take X-raysTake X-rays


Register of DCPs

Opened 31Opened 31stst July 2006 July 2006 2 year transitional arrangements2 year transitional arrangements Dental nurses & dental techniciansDental nurses & dental technicians Existing qualifications ORExisting qualifications OR Experience & demonstrate competency in 6 Experience & demonstrate competency in 6

areasareas


Oral health care in the UK (Daly et al 2002)

Public Sector provision (£1674 million/yr)Public Sector provision (£1674 million/yr) General Dental Services (GDS)General Dental Services (GDS) Community Dental Services (CDS)Community Dental Services (CDS) Hospital Dental Services (HDS)Hospital Dental Services (HDS) Personal Dental Services (PDS)Personal Dental Services (PDS) Dental Defence Agency (DDA)Dental Defence Agency (DDA)

Private Sector provision (£926 million/yr)Private Sector provision (£926 million/yr)


NHS dentistry facts and figures 21,082 dentists (GDS & PDS) - Sept 200521,082 dentists (GDS & PDS) - Sept 2005 GDSGDS

14,377 principals14,377 principals 1,111 assistants1,111 assistants 375 VDPs375 VDPs

PDSPDS 6,809 dentists6,809 dentists 303 VDPs303 VDPs

18.3 million registered adult patients (45%)18.3 million registered adult patients (45%) 7.3 million registered children (62%)7.3 million registered children (62%)

Dental Practice Board, 2005Dental Practice Board, 2005


NHS Services in Medicine and Dentistry

Hospital55%

GMP40%

CMP5%

GDP90%

SPCDS (CDS, PDC, DAC)

5%

Hospital5%

Medicine Dentistry


General Dental Services

National contract covering patient National contract covering patient registration, dentist remuneration & other registration, dentist remuneration & other proceduresprocedures

Dentists independent contractorsDentists independent contractors New contract in 1990 - registration and New contract in 1990 - registration and

emergency ‘out of hours’ provisionemergency ‘out of hours’ provision New contract April 2006 - Units of Dental New contract April 2006 - Units of Dental

Activity (UDAs)Activity (UDAs)


Working in the GDS

Vocational TrainingVocational Training Principals, Associates and AssistantsPrincipals, Associates and Assistants Contract with Primary Care Trust (PCT)Contract with Primary Care Trust (PCT) Monitoring through Dental Reference Monitoring through Dental Reference

Service Service


Community Dental Service

Established in 1974 (from local authority)Established in 1974 (from local authority) Salaried service - terms and conditions Salaried service - terms and conditions

negotiated nationallynegotiated nationally 1700 dentists (1999)1700 dentists (1999) Contractual arrangements with PCT and Contractual arrangements with PCT and

Consultant in Dental Public HealthConsultant in Dental Public Health


The role of the CDS

Treatment of special needs groupsTreatment of special needs groups Specialist referral service (GA, ortho)Specialist referral service (GA, ortho) ‘‘safety net service’safety net service’ ScreeningScreening EpidemiologyEpidemiology Oral Health PromotionOral Health Promotion


Hospital Dental Service

Salaried serviceSalaried service 2500 dentally qualified personnel2500 dentally qualified personnel Provision of specialist dental careProvision of specialist dental care Training of undergraduates and Training of undergraduates and

postgraduatespostgraduates Consultants have parity with medical Consultants have parity with medical

colleaguescolleagues Contractual arrangements with PCTContractual arrangements with PCT


Personal Dental Services

Commenced 1998Commenced 1998 New ways of providing dental careNew ways of providing dental care Pilot sitesPilot sites Three wavesThree waves Dental Access Centres (DACs)Dental Access Centres (DACs) Pilot schemes ended when new GDS Pilot schemes ended when new GDS

contract implementedcontract implemented


Recommended reading

Essential Dental Public Health. Daly et al. Essential Dental Public Health. Daly et al. Chapter 19Chapter 19

www.www.dpbdpb..nhsnhs..ukuk www.gdc-uk.org/www.gdc-uk.org/

PH & Epidemiology - October 2006 The organisation of dentistry in the UK Dr D White.

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