The trends in dental healthcare reform in NHS, UK

Jae-In Ryu; Se-Hwan Jung

doi:10.11149/jkaoh.2017.41.2.144

Journal List > J Korean Acad Oral Health > v.41(2) > 1057729

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Ryu and Jung: The trends in dental healthcare reform in NHS, UK

Original Article

J Korean Acad Oral Health 2017;41(2):144-153.

Published online: 15 June 2017

DOI: https://doi.org/10.11149/jkaoh.2017.41.2.144

The trends in dental healthcare reform in NHS, UK

Jae-In Ryu^1,, Se-Hwan Jung²

¹Department of Preventive and Social Dentistry, College of Dentistry, Kyunghee University, Seoul, Korea

²Department of Preventive and Public Health Dentistry, College of Dentistry, Gangneung-Wonju National University & Research Institute of Oral Science, Gangneung, Korea

Corresponding Author: Jae-In Ryu Department of Preventive and Social Dentistry, College of Dentistry, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea Tel: +82-2-961-0579 Fax: +82-2-961-9594 E-mail: jaeinryu@khu.ac.kr

Received 13 April 2017 Revised 26 May 2017 Accepted 6 June 2017

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

Since 2000, the National Health Service (NHS) in the United Kingdom (UK) has challenged for a large-scale reforms. This study aims to review those reforms to reflect in the dental care system in Korea.

Methods

Reports and papers that were published from 2000 to 2015 and were related to the NHS dental care system and reforms were searched. Among them, official reports from the government or organization were prioritized.

Results

In 2002, the “NHS Dentistry: Options for Change” report suggested rebuilding the structure to meet the standard of care, improving the remuneration system, and modernizing the workforce. Eight years later, the government proposed the “NHS Dental Contract: Proposals for Pilots” to improve accessibility to oral health and dental care. The pilot was based on three elements: registration, capitation, and quality. In 2015, the Department of Health announced the “Dental Contract Reform: Prototypes.” These prototypes include the clinical pathway, measurement and remuneration by quality of care, and a weighted capitation and quality model reimbursement system.

Conclusions

The changes to the UK dental care system has implications. First, national coverage should be extended to improve accessibility to dental care. Second, the dental care system is necessary to reform focused on patient-centered and prevention. Third, registration and remuneration by quality of care needs to be introduced. Fourth, change should start from the basic steps, such as forming consensus or preparing manuals, to strengthening personnel and conducting a pilot study. Most of all, the new system will center on clinical leadership.

Keywords: Delivery of health care, Dental care, Dental legislation, Health manpower, History of dentistry

References

1. Kim CH. Function and importance of health security. Theories of Health Security. Seoul: Hanul Academy;2009. p. 68–104.

2. United Nations Development Programme (UNDP). Human Development Report 1994. New York: United Nations Development Programme (UNDP);1994. p. 1–11.

3. Commission on Human Security. Human Security Now. New York: United Nations;2003.

4. Ruger JP. Rethinking equal access: agency, quality, and norms. Glob Public Health. 2007; 2:78–96.

5. Oliver A, Mossialos E. Equity of access to health care: outlining the foundations for action. J Epidemiol Community Health. 2004; 58:655–658.

6. McArdle LW, Renton T. The effects of NICE guidelines on the management of third molar teeth. Br Dent J. 2012; 213:E8.

7. National Health Service. NHS Plan: A Plan for Investment, A Plan for Reform. London: National Health Service;2000. p. 17–21.

8. Byon JY, Lee HY, Ahn SJ, Kim KA. The 8th, United Kingdom. Trends of medical social security system in several countries. Seoul: National Health Insurance Corporation, Health Insurance Policy Research Institute;2014.

9. Department of Health. Dental Contract Reform: Prototypes - Overview document. London: Department of Health;2015. p. 9–10.

10. Jung SH. General dental care and service system. New dental public health. Seoul: KMS;2012. p. 313–356.

11. Department of Health. Modernising NHS Dentistry: Implementing the NHS Plan. London: Department of Health;2000. p. 3–4.

12. Department of Health. Shifting the balance of power within the NHS. London: Department of Health;2001. p. 5–7.

13. National Health Service. NHS Dentistry: Options for Change. London: Department of Health;2002. p. 34–46.

14. Chief Dental Officer. NHS Dentistry: Delivering Change. London: Department of Health;2004. p. 18–22.

15. Department of Health. Choosing better oral health - an oral health plan for England. London: Department of Health;2005. p. 33–40.

16. Department of Health. NHS Dental Reforms: One year on. London: Department of Health;2007. p. 6–32.

17. Department of Health, The British Association for the study of Community Dentistry. Delivering better oral health - an evidence-based toolkit. London: Department of Health;2014. p. 6–16.

18. The Health Committee. Dental Service, fifth report of session 2007-08. London: House of Commons, Health Committee;2008. p. 15–49.

19. Steele J, Rooney E, Clarke J, Wilson T. NHS dental services in England - an independent review led by Professor Jimmy Steele. London: National Health Serivce, Department of Health;2009. p. 18–37.

20. Department of Health. NHS Dental Contract: Proposals for Pilots. London: Department of Health;2010. p. 9–10.

21. Department of Health. Dental Quality and Outcomes Framework. London: Department of Health;2011. p. 4.

22. Steele J. NHS dental contract pilots - Learning after first two years of piloting. London: Department of Health;2014. p. 11–12.

23. Harris R, Bridgman C. Introducing care pathway commissioning to primary dental care: the concept. Br Dent J. 2010; 209:233–239.

24. Department of Health. Report of the Primary Care Dental Workforce Review. London: Department of Health;2004. p. 6–8.

25. Choi JS, Park DY. Comparison of supplied amount of pit and fissure sealing on the first permanent molars by age and disparity of dental accessibility using National Health Insurance data. J Korean Acad Oral Health. 2016; 40:171–177.

26. Choi ES, Kim HY. Effects of socioeconomic level on dental scaling experience in the community: a multilevel analysis. J Korean Acad Oral Health. 2016; 40:118–125.

27. Lee SM. Registered dentists in Seoul ‘at a glance’ [Internet]. Seoul: Dentists association for healthy society;2016. [cited 2017 Mar 02]. Available from:. http://www.gunchinews.com/news/articleView.html?idxno=35725.

28. National Health Service. Dental Contract Reform Engagement Exercise: Early Findings. London: Department of Health;2012. p. 8–9.

29. National Health Service. Dental Contract Reform Engagement Exercise: Detailed Findings. London: Department of Health;2015. p. 6–11.

30. Gallagher E, Moore A, Schabort I. Leadership training in a family medicine residency program: Cross-sectional quantitative survey to inform curriculum development. Can Fam Physician. 2017; 63:e186–e192.

Fig. 1.

System of Dental care in UK (United Kingdom), NHS (National Health Service) before 2000.

Fig. 2.

Basic elements of the care pathway. *RAG (Red, Amber, Green), ^†NICE (The National Institute for Health and Care Excellence).

Table 1.

List of the papers reviewed

	Year	Authority	Title
1	2000	NHS*	NHS Plan: A Plan for Investment, A Plan for Reform
2	2000	Department of Health	Modernising NHS Dentistry: Implementing the NHS Plan
3	2001	Department of Health	Shifting the balance of power within the NHS
4	2002	Department of Health	NHS Dentistry: Options for Change
5	2004	Department of Health	NHS Dentistry: Delivering Change
6	2005	Department of Health	Choosing better oral health - an oral health plan for England
7	2007	Department of Health	NHS Dental Reforms: One year on
8	2007	Department of Health	Delivering better oral health - an evidence-based toolkit
9	2008	House of Commons Health Committee	Dental Service, fifth report of session 2007-08
10	2009	Department of Health	NHS Dental Services in England - An independent review led by Professor Jimmy Steele
11	2010	Department of Health	NHS Dental Contract: proposals for pilots
12	2011	Department of Health	Dental Quality and Outcomes Framework
13	2014	Department of Health	NHS Dental Contract Pilots - Learning after first two years of piloting
14	2015	Department of Health	Dental Contract Reform: prototypes - overview document

* NHS (National Health Service).

^† web-sites.

1. http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_118522.pdf

2. http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4019304.pdf

3. http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4082278.pdf

4. http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4082278.pdf

5. http://webarchive.nationalarchives.gov.uk/20040719050013/http://dh.gov.uk/prod_consum_dh/idcplg?IdcService=GET_FILE&dID=12823&Rendition=Web

6. http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4123253.pdf

7. http://217.35.77.12/CB/england/papers/pdfs/2007/DH_077237.pdf

8. http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_102982.pdf

9. https://www.publications.parliament.uk/pa/cm200708/cmselect/cmhealth/289/289i.pdf

10. http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_101180.pdf

11. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216670/dh_122789.pdf

12. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216300/dh_126627.pdf

13. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/282760/Dental_contract_pilots_evidence_and_learning_report.pdf

14. https://www.gov.uk/government/publications/dental-prototype-agreements-directions-and-patient-information

Table 2.

Key characteristics of different types of contract

Content	Current contract	Pilot (2012)	Prototypes (2015)
Pathway approach	No	Yes	Yes (refined further)
	(as standard part of approach)
Clinical indicator, DQOF*	No	Yes	Yes (refined measures)
	(as standard part of approach)
Remuneration for DQOF*	N/A	Yes - up to 10% of contract value at risk	Yes - up to 10% of
			contract value at risk
Remuneration for activity	Yes - 100%	No	Yes - covering part care, band 2
			and 3 (Blend A) or band 3 (Blend B)
Remuneration for capitation	No	Yes - covering all care	Yes - covering part care, band 1
			(Blend A) or band 1 and 2 (Blend B)
Financial risk/gain prior to	100% of contract value at risk,	50% of pilots had no financial risk beyond	Great financial risk: All prototypes
DQOF*	4% carry forward and 2%	DQOF* (which was not applied).	will be able to over deliver by 2%
	(with NHS England agreement)	50% were able to over deliver by 2% but	but will also have 10% of contract
	over delivery allowed	also had 2% of contract value at risk	value at risk if there is under delivery
Registration	No	Yes - regulations require patients to be	Yes - as in pilots
		treated as registered
Patient charge	Standard charges apply	3 patient charge bands as in UDA^†	As in pilots
		system + additional charge band for
		prevention only care (interim care)
Assurance	Full performance management	Light touch reflecting fact	Full performance management -
(performance management)		this was pilot approach	to provide as real as possible
			test of the model
Legislative position		Regulations changed,	Regulations changed,
		no primary legislation required	no primary legislation required

*DQOF (Dental Quality and Outcomes Framework),

^† UDA (Units of Dental Activity).

Table 3.

Standardised assessment of a patient’s oral health by RAG status

Status	Red (clinical need)	Amber	Green (no clinical need)
Clinical factors	Current disease	Risk of developing disease (e.g. white spot)	No current disease or risk of developing disease
Patient factors	Cannot be modified by patient factors	Co-existing factors which increase risk (e.g. a patient with poor plaque control)	No factor which increase risk

Table 4.

NHS* dental charges by UDA from 2006

Type	Course of treatment	Charges (£)
Band 1	Examination, diagnosis (eg, X-rays), advice, a scale and polish if needed, and application of fluoride varnish or fissure sealant	15
Band 2	Any further treatment such as fillings, root canal work	41
Band 3	Crowns, dentures, and bridges	183
Urgent	Urgent care	15

TOOLS

Similar articles