Providers of National Health Service dental services have contracts with primary care trusts (PCTs) that set out the agreed annual contract sum and the corresponding level of services to be provided over the course of the year. These annual service levels are expressed mainly in units of dental activity, which measure courses of treatment according to their relative complexity. Dental providers who under-deliver by up to 4 per cent may carry this forward and make up the activity in the following year. Where a provider has delivered less than 96 per cent of the agreed annual service level, it is at the PCT's discretion whether the undelivered activity is carried forward to the following year or an appropriate proportion of the annual contract sum is refunded to the PCT. This is a matter for PCTs to decide locally in the light of individual circumstances, and their decisions are not collected or held centrally.
The new general dental services contract does not in itself apply to salaried primary dental care services. However, the accompanying move to local commissioning of dental services provides a significant new opportunity for primary care trusts (PCTs) to develop more integrated services—across the spectrum of general dental services, salaried primary dental care services and hospital services—that meet the needs of all patients including those with a need for special care.
The inclusion of salaried primary care dentists in PCTs' dental performers lists from July 2006 should further benefit patients through the introduction of common performance standards across primary care.
In making net financial allocations to primary care trusts (PCTs) for National Health Service dental services, it is only possible to make indicative assumptions about the levels of income that will be raised from patient charges in each PCT area. The actual level of charge income will depend on a range of local factors, including the type of dental services commissioned and the relative proportion of treatments given to charge-paying patients and those exempt from charges.
Where the level of patient charge income is below the indicative amount assumed in a PCT's allocation, this does not affect the level of services agreed under existing contracts. The new dental contracts that took effect from April 2006 set out the annual contract value and the corresponding level of services to be provided over the course of each year. PCTs cannot reduce these agreed contract values or service levels because patient charge income is below expected levels.
It is for PCTs to assess local needs for NHS dental services in their area and to develop commissioning plans that reflect these local needs, taking account of the overall resources available.
The Government are fully committed to supporting the National Health Service in developing dental services for the longer term. The 2006 reforms established, for the first time, a statutory duty on primary care trusts (PCTs) to provide or commission dental services to reflect local needs. The proposal to move resources for dentistry into PCTs' main health budgets from 2009-10 is designed to reinforce further the importance of developing dental services, based on the same principles that underpin commissioning of other NHS services, including public and patient involvement and professional engagement.
The department is supporting a wide-ranging programme to help PCTs develop dental services both now and in the longer term, including supporting PCTs in assessing local needs and developing commissioning strategies, building on additional investment of some £400 million in the last three years and a further £100 million programme of capital investment, spread over 2006-07 and 2007-08, in premises and equipment. To support continued growth in the NHS dental workforce, the department has also invested in a 25 per cent expansion in undergraduate dental education, with the first students from this expanded programme due to graduate and begin their NHS vocational training in 2009.
Primary care trusts and local providers of National Health Service dental services are responsible for seeking to resolve any disputed elements of NHS contracts. If the parties cannot reach a local resolution, the dispute can be referred to the NHS Litigation Authority. The NHS primary care contracting team offers and provides support and advice on dispute resolution to those commissioners who request it.
Eighty-seven per cent of all those contracts originally signed in dispute have so far been resolved. Well over 99 per cent of the disputes so far resolved have ended in the dentist deciding to stay with the NHS.
Guidance to primary care trusts on National Health Service orthodontic assessments and the index of orthodontic treatment need is set out in Strategic Commissioning of Primary Care Orthodontic Services, which is available at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4139176
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