Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 40 - 59)



Mrs Gordon

  40. The evidence we have had so far I find pretty depressing. We have just finished an inquiry into public health issues and it seems to me that dentistry has no connection at the moment, or very little connection, with the public health agenda. I do not know if you want to comment on that. A lot of people simply cannot afford private dental care. Modernising NHS Dentistry indicates that patients often do not realise where NHS treatment is available and are unsure whether they are getting NHS or private treatment. There seems to be a sort of break down in communications. I would like to address this to the two Association members really. How do you ensure that your dentists communicate with the public or are you, in a way, trying not to attract NHS business by not communicating?
  (Mr Renshaw) The problem that we have got is we do not have one single problem and there is no one single solution that is going to put it all right. We have the problems of the rural areas, we have the problems of the inner cities, we have the problems of deprived populations, we have the ethnic minority problems, we have cultural difficulties amongst them and we have people with special needs. We also have a range of solutions, one of which is the GDS, the other is the Community Dental Service that is struggling away to provide a service for people with particular needs. We also have new solutions coming along with the Personal Dental Service and Access Centres. At long last somebody is beginning to look at some of these problems, and not before time I have to say. This is long overdue. The options do not stop there. I would say that emergency care now for dental problems is 1,000 per cent better than it was in 1990 because before 1990 there was no responsibility on dentists to provide an emergency service at all. What we have discovered is an absolute mountain of need that was swept under the carpet before. We are now dealing with an enormous amount of emergency work but it is not enough. The hospitals cannot cope, they are not equipped to deal with toothaches and things like that. The problem has been in the last few years that dentistry has become detached from the rest of the NHS, it is seen as somehow off to one side. What we are trying to do is to get that back into the mainstream of the NHS so that it is dealt with properly as part of a full blown Health Service. A Health Service that does not provide dentistry, whether it is in the centre of Wakefield or in the centre of Woking, is not a proper service, is it, it is not doing its job properly. We do have lots and lots of ideas. In fact, in your own constituency, Chairman, we have seen a Community Dental Service that was defunct, that has been restaffed and re-emerging in one of the worst areas of Wakefield.


  41. There are not any bad areas of Wakefield, dear me.
  (Mr Renshaw) I am sorry, there are not any bad areas in Wakefield. I should know, I come from about seven miles away.

  42. Yes, I know you do.
  (Mr Renshaw) My memory is obviously playing tricks with me.

  Chairman: You have not been there for a while.

  John Austin: It has got better since you were elected.

Mr Gunnell

  43. You are talking about the time before David was representing the area.
  (Mr Renshaw) Absolutely, yes, because it has obviously improved immensely since. There are different ways of tackling these problems. One of the good things that comes out of the so-called strategy is the move to give health authorities more leverage at a local level to actually work out for themselves what would be the best solution and to work with the profession locally to find out how to deal with these problems. At national level I cannot sort out and I cannot be aware of every problem in the North West and the South East or the South West, the people locally have to be given the power and the funding to be able to sort out those problems for themselves. That is one of the most impressive things. Whether or not the health authorities will be able to deliver on that I think is open to question, and you are going to be talking to some health authority people shortly which will help to explain it for you. There is hope but we have got to get away from this detachment of dentistry from the main Health Service, it is not a different part of the world.

Mrs Gordon

  44. Have dental practices been involved in any of the Health Action Zones throughout the country or have they taken part in any of the new projects?
  (Mr Renshaw) Yes. I know for a fact that in Bradford they have been heavily involved, and in Manchester. I am sure that if we looked around we would find evidence of their involvement elsewhere too. Health Action Zones are definitely one of the things that we have been involved in.


  45. Picking up the point about bringing dental treatment more into the mainstream, what are your thoughts about the way in which increasingly we have the PCGs and PCTs and Care Trusts and the way we are concentrating a range of services within the community on a common basis? For example, my own GP practice in Wakefield has got a series of services, an NHS walk-in centre, emergency medics there at the weekend and overnight. One of the concerns I have got is that we may have a problem bringing you more closely into that sort of arrangement by virtue of the vested interest you have in your own practices. Clearly that is a means of making money for yourselves, and I understand that, but can you see a way forward on that so that if I go to my local medical centre I can in the future also access dentistry?
  (Mr Ross) I take slight disagreement with the comment that investing in our own practices is a way of making money.

  46. A number of dentists have told me in detail about the way in which clearly they are interested in ensuring that their property is modernised and—
  (Mr Ross) Again, unlike medical practices, it all comes out of our own pockets.

  47. I understand that you invest in it.
  (Mr Ross) Heavily invest.

  48. I understand that, but what I am trying to say is how can we get you to invest instead perhaps in being alongside GPs and health visitors as in the model that we see in Northern Ireland where everybody works under one roof, which makes sense?
  (Mr Ross) We discussed this with Lord Hunt at a meeting last week. The answer is with huge, huge difficulty. There are something like 15,000 individual dental practices out there, many of them single-handed. Yes, it sounds like an ideal scenario if all these practices were to work side by side but you are trying to undo 50 years of the development of a profession which has gone along a divergent path from that of the medical profession. Great if you can work it, but that is going to take a huge amount of money.

  49. But you are talking about the need for a long-term strategy and that may be part of that strategy that we need to look at with young dentists and new practices.
  (Mr Renshaw) The answer is to not make the gigantic leap from where we are today to somewhere out into the future in one gigantic bound of hopefulness and energy because, frankly, that is a disaster.

  50. I am not suggesting that. You were talking about a long-term strategy, would you not agree that is a goal we should aim for?
  (Mr Renshaw) Yes.

  51. Looking at practical steps between where we are now and where we want to be?
  (Mr Renshaw) Yes, but the point I was going to make was every year in this country we register some 1,700 new graduates who come on to the lists. Those people do not have money tied up in business already and they are looking for jobs. There has got to be an opportunity there to look at providing them with opportunities to work in this kind of scenario that would fit in with your model. You do not have to turn the whole thing over in one fell swoop.

  Chairman: We are talking about tackling the issue of integration, bringing you into the mainstream, looking at bringing new recruits into dentistry, looking at how we may get them based in primary care centres. Perhaps we need to touch on this in the next session with the health authorities because they will have a role to play. Eileen, have you finished?

Mrs Gordon

  52. I just want to pick up on the point that, for example, if somebody is in an inner city area, how do you let them know where the NHS dental practices are?
  (Mr Renshaw) At the moment the patient has to ring the health authority to find out. It is a real torturous process and I am not sure that many people who live in inner cities have in their diaries the number of the local health authority, it is not that easy to find. I know if you look in the directory you can find it, but it is not so easy.

John Austin

  53. What do you look under?
  (Mr Renshaw) Yes, exactly. If you look under "health authority" it usually refers you to the right one. You need to know that "health authority" is the right place to look. What is being suggested is that NHS Direct will be able to do this in the future and we are quite content with that, we do not have a problem with that. If health authorities can pass their information on to NHS Direct then the patients can access that information much more easily. Our concern with that is trying to keep that information up to date is going to be a mammoth task and we are concerned whether or not NHS Direct is going to be able to deliver on this promise. We think it is a good idea but we are not convinced that it is immensely practical to start with. I am concerned that we tell patients they can ring NHS Direct but when they ring they will not get the right answer.

Mrs Gordon

  54. Do you feel that you have any responsibility to share this information about where NHS treatment is available through the health clinics and health visitors, the people who are actually going into the inner city areas and meeting these people?
  (Mr Renshaw) The vast majority of practices are already in touch with their health authorities on a regular basis and they are asked on a regular basis whether they have room, whether they are taking patients on or not, and therefore the situation already exists. The health authority's role ought to be to disseminate that information, it is not for the individual practitioner to have the problem of making sure the information gets out there for NHS patients, surely that has to be a role for the health authority.

Mr Gunnell

  55. Mr Renshaw mentioned earlier the development of Dental Access Centres and you seemed to be giving that a positive welcome. Can you say whether that sort of change ought to be enhanced or accelerated?
  (Mr Renshaw) The use of Access Centres is beginning to show that they attract a group of clientele who do not normally access General Dental Practitioners. Therefore, if they are adding a new string to the patient's bow then I think that has to be a positive move. One of the most impressive things about the Access Centres is they are beginning to show they are attracting the age group between 18 and 25, who we know for a fact tend to be lost to the General Dental Service because at that point they have to start paying for treatment. I know they are not getting free treatment in the Access Centres but they seem to be deciding to go there instead of going to an ordinary High Street dentist. I think that Access Centres do have a role to play and they certainly have a role to play in areas where the population locally do not normally access routine dental care, or where there is not any availability of routine dental care. I do not have a real problem with it. I do have a concern to make sure they are not put in places where they compete with existing services. When we have a shortage of manpower there is no point in starting setting up rival services within towns and cities, that is nonsense.

  56. Is the development of Access Centres, what shall we say, haphazard?
  (Mr Renshaw) No.


  57. Can we bring in our colleagues who are practising dentists. I know you are a practising dentist but could we just hear Mr Bosley and Dr Husband on that point.
  (Dr Husband) I feel that Dental Access Centres do have a role, however I am very concerned as to who is actually going to work in them. We have a huge shortage of dentists in General Dental Practice, so where are all these new practices and people going to come from and what are the incentives to work there? Working with such people for emergency care is very demanding. I do not really think that young dentists perceive it as a career move. We do not know how long they are going to be around and we do not know where the next decision is coming from and for how long.
  (Mr Bosley) I know little about them but my researches indicate that they are fairly expensive compared to general practitioners providing similar services and that they actually only provide services for a few. Something we have skated over this morning is manpower. Manpower, or the absence of manpower, is a fundamental problem for our profession, so every patient that is saved by an Access Centre possibly means that another patient is not saved elsewhere. We must look hard at manpower.

Mr Gunnell

  58. Do you find in general the number of recruits to the profession is at a fairly stable level, or is it falling?
  (Mr Bosley) The universities closed three teaching departments ten years ago and cut their whole input, so the number of dentists on the register is much the same year on year, although we are now a net importer of dentists trained from other countries.
  (Dr Husband) It is still a very popular profession because the universities are constantly over-subscribed and the grades to get in to do dentistry have rocketed since I went.
  (Mr Bosley) There is only one of me for every 3,300 of you and I cannot service 3,300 of you.

  59. No, clearly not. In general is the Government doing enough to promote the industry as a profession?
  (Mr Bosley) It needs to open up the university teaching departments again.

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