Examination of Witnesses (Questions 40
THURSDAY 15 FEBRUARY 2001
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
41. There are not any bad areas of Wakefield,
(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
Chairman: You have not been there for a while.
John Austin: It has got better since you were
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.
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
(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
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?
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.
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.
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
(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
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
(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
(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.
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