The main agency through which the Government support medical and clinical research is the Medical Research Council (MRC). The MRC is an independent body funded by the Department of Trade and Industry via the Office of Science and Innovation. Details of current and recent MRC dental and oral health projects are shown in the table.
Principal investigator Organisation/host institution Project title Total amount awarded (£) Dr. L. F. Donaldson University of Bristol Periodontal disease and the relationship between chronic inflammation and pain 471,556 Professor P. Sharpe King’s College, London—GKT Schools NFkB/Rel—TNF interactions controlling tooth development 407,219 Professor M. A. Curtis Queen Mary and Westfield College Mechanisms of susceptibility to periodontal disease 101,344 Dr. L. M. C. Hall Queen Mary and Westfield College The rag locus of Porphyromonas gingivalis—horizontal gene transfer and virulence in a periodontal pathogen 274,510 Dr. S. H. Kilcoyne University of Leeds Novel Aesthetic Dental Restorative Materials 44,754 Professor J. C. Elliott Queen Mary and Westfield College Geochemical expertise to improve understanding of physical chemistry of dental caries and biological calcium phosphates 48,224 Professor R. Cywinski University of Leeds Optimisation of restorative materials via 3-D strain/texture analysis of dental enamel 59,725 Professor M. A. Curits Queen Mary and Westfield College Pathogenesis of Periodontal Disease: Generation of Molecular Diversity in the Proteases of P. gingivlis 746,449 Professor M. A. Curtis The Royal London Hospital Medical College Pathogenesis of Periodontal Disease: Generation of Molecular Diversity in the Proteases of P. gingivlis 1,597,210 Professor J. C. Elliott Queen Mary and Westfield College Mechanisms of de-and remineralisation in dental enamel 493,289 Professor P. Sharpe King’s College, London—KCL Molecular and cellular mechanisms of dental patterning 846,053 Professor I. Chapple University of Birmingham Differential neutrophil gene expression in chronic adult periodontal disease 114,224 Dr. H. Peters University of Newcastle-upon-Tyne Functional analysis of genetic interactions affected in non-syndromic cleft lip/palate formation 325,752 Professor M. A. Curtis Queen Mary and Westfield College Characterisation of the common steps in the glycosylation of Arg—gingipains and synthesis of LPS and APS of P. gingivalis 585,132 Professor M. Wilson Eastman Dental Institute Detection and characterisation of genes encoding antibiotic resistance in the cultivable and non-cultivable oral mircofl 282,010 Professor K. O’Brien University of Manchester The long-term effects of orthodontic growth modification for severe class II growth anomalies 374,464 Professor J. C. Elliott Queen Mary and Westfield College Mechanisms of de-and remineralisation in dental enamel 493,289 Mr. V. Lopes University of Birmingham Gene expression profiling in normal, premalignant and malignant oral mucosa 144,356
The Department funds research to support policy and to provide the evidence needed to underpin quality improvement and service development in the national health service. Current and recently completed research related to dental health and forming part of the NHS national programmes includes:
A systematic review of the effectiveness and cost-effectiveness of HealOzone for the treatment of occlusal pit/fissure caries and root caries.
Chief investigator: Aberdeen health technology assessment (HTA) group, University of Aberdeen
Cost: circa £50,0001
The cost-effectiveness of screening for oral cancer in primary care.
Chief investigator: Professor Paul Speight, University of Sheffield
Cost: £67,331 over five years
High performance bioactive structures for bone replacement and tissue growth.
Principal investigator: Dr. Russell Harris, Loughborough University, Leicester.
Cost: £237,943 over three years
Refinement and in-vivo performance of implanted composite structures.
Principal investigator: Dr. Colin Anthony Scotchford, University of Nottingham
Cost: £156,300 over three years
A new and emerging applications technologies programme feasibility study of advanced material/bone interface analysis using four computerised tomography.
Mrs. Sheila Fisher, University of Leeds
Cost: £34,351 for one year
The Department also supports the oral health research and development support unit based at university of Manchester. The unit’s research director is Professor Martin Tickle. It receives an annual grant from the Department of £100,000. Its purpose is to:
expand research capacity in dentistry;
develop the research infrastructure in primary dental care; and
increase research outputs to improve dental services for patients.
More information about the work of the unit, including details of current and completed research, can be found at www.ohu.ac.uk
Over 75 per cent. of the Department’s total expenditure on health research is devolved to and managed by NHS organisations. Details of individual projects including a large number concerned with dental health are available on the national research register at www.dh.gov.uk/research
1 This project was commissioned by the HTA programme on behalf of the National Institute for Health and Clinical Excellence on a call-off contract basis so an exact figure is not available.
The responsibility for the performance management of primary care trusts (PCTs) rests with strategic health authorities (SHAs). The Chester-le-Street PCT and the County Durham and Tees Valley SHA continue to receive support from the NHS dentistry support team in developing a commissioning plan for NHS dentistry provision in the PCT area.
The support team will work with the PCT to develop a robust commissioning strategy, along with providing advice on recommisioning and tendering. This exercise will be conducted in discussion with the four neighbouring PCTs which will merge with the Durham and Chester-le-Street PCT to form the new County Durham PCT from October 2006.
Approximately £1 million remains in the PCT's dental allocation to recommission additional dental services for its population, with the potential to provide an additional seven fully committed NHS dentists.
Resources are allocated directly to primary care trusts (PCTs) to be used according to the healthcare needs of their local populations. Funding for salaried dental services forms part of their unified budget. It is the responsibility of PCTs to commission salaried dentist services, using funding from this budget according to the needs of their local populations and against national priorities.
It will be for strategic health authorities and primary care trusts to make decisions locally on priorities for deploying the £100 million capital investment for NHS primary dental care services announced on 18 May. We intend to publish guidance shortly on potential ways in which this funding could be used most effectively to support dental practices and improve patient services, but we do not intend to ring-fence any element of the funding for specific types of investment.
As part of a major investment programme for the expansion of dental education, we announced in January the establishment of a new Peninsula dental school with bases in Plymouth, Devonport and Truro and the development of outreach dental education in Central Lancashire and Hull. It is for higher and further education institutions to determine the provision they make for the training of dental technicians. I understand a number of dental schools are considering whether provision for the training of dental technicians could be incorporated into the expansion programme, but no specific proposals have yet emerged.
The Department has established an implementation review group comprising dentistry, patient and national health service representatives to review the impact of the recent dental reforms. The group will shortly be considering how most effectively to assess outcomes under the new arrangements. It will take time for sufficient treatments to have been completed to allow a meaningful assessment, particularly in relation to complex treatments.
The Department does not allocate funds to dental technology or dental laboratories. The costs involved in having dental appliances manufactured for national health service patients are met by general dental practitioners from within the overall remuneration they receive for providing NHS services.
The NHS Business Services Authority (BSA) reports that 2 per cent. of the payments due to dentists since 1 April have been found to have been incorrect, 4 per cent. were not paid on the due date and 1 per cent. were both paid after the due date and later found to be incorrect. The BSA, in liaison with the relevant primary care trusts, has already corrected or is in the process of correcting these payments.
Data for 1980 are not held centrally by parliamentary constituency.
As at 31 March 1997, there were 35 national health service dentists in the Shrewsbury and Atcham parliamentary constituency. At the same point in 2005 there were 80 NHS dentists.
The England figure as at 30 September 1980 was 13,591. The number of NHS dentists in England as at 31 March 2005 was 20,088.
Notes:
1. A dentist with a general dental service or personal dental service contract may provide as little or as much NHS treatment as he or she chooses or has agreed with the primary care trust. Information concerning the amount of time dedicated to NHS work by individual dentists is not centrally available.
2. Data on dentists who work only in private practice are not held centrally.
3. Dentists consist of principals, assistants and trainees. Prison contracts have been excluded.
4. The postcode of the dental practice was used to allocate dentists to specific geographic areas.
Sources:
The Information Centre for health and social care
NHS Business Services Authority
Resources for primary dental services, including orthodontic services, have been allocated to primary care trusts for 2006-07 on the basis of expenditure on general dental services and personal dental services during the reference period October 2004 to September 2005, adjusted for pay uplifts and with some allowance for subsequent growth in services.
The index of orthodontic treatment need is not designed as a basis for resource allocation, but as a way of ensuring that needs assessment is carried out more fairly and that resources are targeted on those with the greatest needs.
It is now the responsibility of the strategic health authorities to assess future work force needs and make decisions on number of training places. In 2005, the work force review team, which works on behalf of the national health service to co-ordinate and synthesise information about the health work force in England, made estimates for the requirement for the numbers of whole time equivalent hospital based orthodontic consultants and projections for staff in post as follows:
Requirement Orthodontic consultants 2005 264 184 2006 264 192 2007 264 199 2008 264 199 2009 264 202 2010 264 203 2011 264 203 2012 264 207 2013 264 204 2014 264 201
Orthodontic specialists work in both hospitals and primary care settings including high street dental practices. The new commissioning arrangements introduced in April 2006 will in the future enable primary care trusts (PCTs) to plan and commission services across primary and secondary care trusts. We are looking to develop services outside hospital by encouraging PCTs to contract with specialists working in the community and, where appropriate, general dental practitioners with a special interest in orthodontics.
The representations that the Department has received from orthodontists have focused largely on new or growing orthodontic practices, where the value of their most recent national health service caseload (prior to the implementation of the recent dental reforms) exceeds their NHS earnings during the October 2004 to September 2005 reference period used for calculating minimum guaranteed contract values under the new arrangements. It is for primary care trusts to decide locally whether and, if so, how far to adjust contract values in these circumstances, based on assessment of local needs and taking into account local priorities.
New arrangements are designed to provide a more consistent method of assessing orthodontic needs and enable primary care trusts (PCTs) to target resources more accurately on children with the greatest needs.
PCTs will need to form a local view on whether to reduce, maintain or increase the level of orthodontic activity commissioned from dentists in line with the local population’s needs and local priorities. It is too early to make any assessment of changes in levels of access to orthodontic treatment.
This information is not collected in the form requested.
Information will be available in due course via the NHS business services authority on the numbers of patients who receive care or treatment from national health service primary care dentists on one or more occasions within a given period of time. This will provide a measure that is broadly similar to that of patient registration under the former system of general dental services. We expect the first information to be available in the autumn.
This proposal, which was made by the European Commission as part of their recommendations to amend the medical devices directive 93/42/EC, is still under negotiation between member states in the Council of Ministers working group and no final decision has been reached. The United Kingdom Government will implement whatever amendment is made to the directive in this respect once it has been ratified by the European Parliament.