The Incisal Edge

For the second time in less than a decade the Office of Fair Trading has investigated the Dental Market, their report was released today; the press release is below, I find it interesting that the press release is far more dramatic in it’s summary than the report itself, but that’s government spinners for you:

OFT calls for greater patient choice and competition in dentistry market.

The OFT today called for major changes to the £5.73bn UK dentistry market after a market study found that it is not always working in the best interests of patients.

The OFT study found that patients have insufficient information to make informed decisions about their choice of dentist and the dental treatments they receive. Alongside this, a new survey conducted as part of the study suggests that each year around 500,000 patients may be provided with inaccurate information by dentists regarding their entitlement to receive particular dental treatments on the NHS, and as a result they may pay more to receive private dental treatment.

The report also raises concerns about continued restrictions preventing patients from directly accessing dental care professionals, such as hygienists, without a referral from a dentist. The OFT considers these restrictions to be unjustified and likely to reduce patient choice and dampen competition.

The OFT also highlights concerns with the current NHS dental contracts in England. As the majority of these contracts are not time-limited, and only a small volume of new contracts are put out to tender each year, it is extremely difficult for new dental practices to be established, and successful dental practices which offer a higher quality of service to NHS patients are prevented from expanding.

Other issues of concern highlighted in the report include the complexity of the complaints process for patients and instances of potential pressure selling by dentists of dental payment plans.

The OFT has identified a wide-ranging package of recommendations to address these concerns, which includes:

• Provision of clear, accurate and timely information for patients – the OFT is calling on NHS commissioning bodies, the General Dental Council and the Care Quality Commission to be proactive in enforcing existing rules which require dentists and dental practices to provide timely, clear and accurate information to patients about prices and available dental treatments.
• Direct patient access to dental care professionals – the OFT urges the General Dental Council to remove restrictions preventing patients from making appointments to see dental hygienists, dental therapists and clinical dental technicians directly, as soon as possible.
• Reform of the NHS dental contract in England – the OFT is urging the Department of Health to redesign the NHS dental contract to facilitate easier entry into the market by new dental practices and allow successful practices to expand. The OFT is not convinced that indefinite contracts to supply NHS dentistry are in the best interests of patients.
• Simplification of the complaints process – the OFT considers that the current system should be reformed to make it simpler, easier and less time consuming for patients and dentists to resolve complaints.
• Sale of dental plans – following discussion with the OFT, the British Dental Association has agreed to develop a robust and effective code of practice covering the sale of dental payment plans.

John Fingleton, OFT Chief Executive said:

‘Our study has raised significant concerns about the UK dentistry market which need to be tackled quickly in the interest of patients. All too often patients lack access to the information they need, for example when choosing a dentist or when getting dental treatment. We also unearthed evidence that some patients may be receiving deliberately inaccurate information about their entitlement to NHS dental treatment, and we expect to see robust action taken against such potential misconduct by dentists.

‘This study has also highlighted that the current NHS dental contract in England may well not be working in the best interests of patients, (my bold) and that regulations unjustifiably restrict patients from getting direct access to dental care professionals like hygienists. Reform in both these areas is needed without delay.’

NOTES

1. Download the market study report.
2. OFT market studies are carried out under section 5 of the Enterprise Act 2002 (EA02) which allows the OFT to obtain information and conduct research. Effectively, they allow a market-wide consideration of both competition and consumer issues. They take an overview of regulatory and other economic drivers in the market and consumer and business behaviour. Possible outcomes of market studies include: enforcement action by the OFT, a market investigation reference to the Competition Commission (CC), recommendations for changes in laws and regulations, recommendations to regulators, self-regulatory bodies and others to consider changes to their rules, campaigns to promote consumer education and awareness, or a clean bill of health.
3. The OFT has provisionally concluded that it is not appropriate to make a market investigation reference on the UK dentistry market to the Competition Commission at this time, and invites views on the proposed decision. Interested parties are invited to submit responses to this consultation by 5pm on 10 July 2012 to dentistry@oft.gsi.gov.uk or in writing to the Dentistry Market Study Team, Services and Infrastructure Group, Office of Fair Trading, London, EC4Y 8JX.
4. The OFT is unable to provide advice or resolve individual complaints for consumers. The Citizens Advice consumer service provides free, confidential and impartial advice on consumer issues. Visit http://www.adviceguide.org.uk or call the Citizens Advice helpline on 08454 04 05 06

Now compare with their conclusions in 2003.

Purpose of the study
To address competition concerns and concerns regarding levels of consumer protection in the market.
To investigate transparency of prices, the level of competition and the way complaints are handled and redress offered. To look at access to dental services and patient guidance before treatment.

Findings

The findings of the study showed:

1. Consumers lack basic information on price, quality of service and treatments available on the NHS so unable to make informed choices.
2. Standards promoted in professional guidance published by the General Dental Council (GDC) not routinely monitored/enforced, and compliance in some areas low.
3. Unlike the NHS, there was no universal complaints system, and procedures for dealing with complaints and securing redress for consumers were inadequate.
4. Regulatory restrictions on the supply of dentistry services limited consumer choice, competition, business freedom and the potential to develop and deliver better services.

Recommendations
The recommendations of the study were to:

1. Improve consumer information through better self-regulation The regulatory framework should be strengthened and broadened to help ensure that consumers can make properly informed decisions about dental services. Compliance with the standards for patient information set out in the existing GDC guidance to dentists should be monitored and enforced
2. Improve resolution of problems, complaints and redress Each practice should have a complaints procedure and patients should be made aware of this when they register with the practice. In line with NHS procedures, an independent complaints procedure should be established to examine complaints which could not be resolved at the practice level
3. End restrictions on certain professionals complementary to dentistry (for example, hygienists), so that they were free to supply their services directly to consumers. Support for Department of Health (DH) proposals to remove the restriction on the number of corporate dental bodies under the Dentists Act. Urged DH to consider removing the remaining restrictions.

Action following market study
All the OFT recommendations were accepted.

1. The Dental Complaints Service, an independent complaints service funded by the General Dental Council (GDC), was established in March 2004 to help resolve complaints for private dental patients, with sanctions against dentists who fail to reveal all the options and full costs.
2. Changes to s60 Health Act 1999 removed restrictions on certain professionals and allowed the GDC to register additional care professionals.
3. OFT also carried out an awareness campaign – with a consumer information leaflet published in 2006 so that consumers of private dental services knew what information they needed and had a right to expect.

My thoughts

• The Independent Dental Complaints System has been a great success, it is efficient and works well for both parties in a dispute. The NHS systems, however, particularly if PCTs get involved has resulted in a massive escalation in complaints leading to a backlog of cases waiting to be heard by the GDC; this hasn’t been helped by the GDC changing their standards for what complaints have to be taken further.
• The changes to the health act did little or nothing to remove restrictions on hygienists etc to work independently (whether that be right or wrong remains to be seen). Instead they have escalated the number of registrants with the GDC by including Dental Nurses, this has led to a fall in morale and the departure from the profession of many experienced Dental Nurses. So the DoH dropped the ball there.
• The removal of restrictions on corporate dental bodies has led to the proliferation of dental “factories” which have been able to take advantage of the changes introduced in the 2006 contract which the OFT says “may well not be working in the best interests of patients” – with all due respect to the OFT, any and every dentist could have told them that the contract has been a disgrace and everybody involved in its conception and implementation, from CDO down, should be ashamed of themselves.
• This report is just another stick to beat dentists and their teams – I am not trying brush over the fact that some dentists are less than true to themselves and their patients about where NHS coverage ends and what they are providing privately. Surely its time to say that you’re either NHS, with a limited budget where GDPs are salaried or you’re part of the free market where you provide what you wish at the price that is able to reflect the time spent, materials used and the investment made in updating your premises.
• The Big Lie (thanks to Tony Kilcoyne) is that there is not enough money to provide a dental service on the terms set down by the Department of Health and no reports, commissions and investigations will change that, until everybody involved in UK dentistry admits this from the DoH including the BDA, dentists and patient groups then the system will remain unfit for purpose as government is so fond of saying.

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Just what you need to keep ahead of the opposition…

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