The dental budget of England’s National Health Service (NHS) isn’t being spent efficiently and should be better allocated to prevent oral health inequality and meet the needs of patients, report researchers at Newcastle University, who note that public money used for NHS dentistry is based on historical demands rather than evolving with the needs of patients.
Instead, the researchers say, funds should be much more focused on prevention of decay and gum disease and on providing more accessible services. Improvements would include opening new NHS high street practices, greater provision of dentistry in care homes, direct booking of dental appointments from the NHS helpline, and including more oral health measures in contracts for local authority services.
The tradeoff, the researchers say, would be a reduction in the amount of orthodontics that the NHS provides by not treating those with moderate need and not providing adult orthodontics and by stopping the routine scaling and polishing of teeth.
“Public money used for NHS dentistry is not being spent in the most effective way to ensure that patients are given the best care possible,” said Chris Vernazza, BDS, PhD, clinical senior lecturer at the Newcastle University School of Dental Sciences and leader of the RAINDROP project, which conducted the study with funding from the National Institute for Health Research.
“Our RAINDROP project shows much of the dental budget is spent on high street dentistry, but significant amounts are also spent on specialist oral surgery and orthodontic services, with very little spend on oral disease prevention. We estimate the current NHS dentistry budget includes only a tiny provision for prevention of oral disease, less than 5%, and this is not enough,” said Vernazza.
“We have recommended a specific set of services we would like to see new investment in and a set of services that should have funding reduced to allow this investment,” said Vernazza.
The RAINDROP project was set up to identify a better system for making decisions around changing how the NHS dental budget is spent, trying to satisfy multiple criteria, including determining public views in a way that represented the whole of society.
A panel of patient representatives, dental network chairs, dental lead commissioners, dental public health consultants, and an academic assessed the current funding model and services, exploring more effective models of care. NHS budgets currently are set regionally, but the funding arrangements often maintain historic allocations, partly due to lack of resources to review current allocations.
Each panel member scored a variety of dental services such as examinations, oral surgery, out of hours, restorative, and orthodontics to identify the changes needed to dental health budgets. The panel presented its findings to the Office of the Chief Dental Officer and others and NHS England, who will now consider the resource allocation recommendations.
“Major changes, such as those we have recommended, are often difficult to implement at a national level. It may be that any changes need to be made as part of ongoing and emerging processes, such as dental contract reform, which is currently scheduled for rollout next year,” Vernazza said.
“In addition, at regional level, opportunities may present which would allow implementation of parts of our recommendations,” said Vernazza. “The focus is on improvements for the whole population, so individual patients may see different levels of benefit. The sooner changes are made, the sooner potential benefits can be realized.”
The RAINDROP team is now embarking on a series of engagements with key stakeholders to explain and explore the project and its findings.