1. PH & Epidemiology - October 2006 The organisation of dentistry in the UK Dr D White

2. PH & Epidemiology - October 2006 Outline Historical perspective Historical perspective The role of the General Dental Council The role of the General Dental Council The dental team The dental team Dentistry within the NHS Dentistry within the NHS

3. PH & Epidemiology - October 2006 Dentistry within the NHS (1948) Tripartite system Tripartite system  Hospitals  general / dental  Local Authorities  school dentists  General Dental Practitioners  independent contractors

4. PH & Epidemiology - October 2006 Changes since 1948 NHS reorganisations NHS reorganisations  1974, 1982, 1990  Little effect on GDS

5. PH & Epidemiology - October 2006 NHS dental services following 1990 reorganisation Purchasers Purchasers  Local commissioning authorities (DHA)  (GMP fundholders) Providers  Hospital Trusts  Community Trusts General Dental Practitioners

6. PH & Epidemiology - October 2006 General Dental Council Regulatory Body for Dentistry Regulatory Body for Dentistry Compulsory registration for dentists, therapists and hygienists Compulsory registration for dentists, therapists and hygienists Continuing Professional Development Continuing Professional Development Complaints Complaints Quality Assurance of Dental Education Quality Assurance of Dental Education Publications – consent, confidentiality etc Publications – consent, confidentiality etc

7. PH & Epidemiology - October 2006 The Dental Team Dentist Dentist Dental Care Professionals (DCPs) Dental Care Professionals (DCPs)  Nurse  Hygienist  Therapist  Technician

8. PH & Epidemiology - October 2006 Dental Hygienist Diploma – 2 year course Diploma – 2 year course Work to dentist’s prescription Work to dentist’s prescription Clean, scale & polish teeth Clean, scale & polish teeth Apply prophylactic materials Apply prophylactic materials Administer local anaesthetic Administer local anaesthetic

9. PH & Epidemiology - October 2006 Dental Therapist 2 – 3 year course (may be BSc) 2 – 3 year course (may be BSc) Work to dentist’s prescription Work to dentist’s prescription Extract deciduous teeth Extract deciduous teeth Simple dental fillings Simple dental fillings Clean, scale & polish teeth Clean, scale & polish teeth Apply prophylactic materials Apply prophylactic materials Administer local anaesthetic Administer local anaesthetic Take X-rays Take X-rays

10. PH & Epidemiology - October 2006 Register of DCPs Opened 31 st July 2006 Opened 31 st July 2006 2 year transitional arrangements 2 year transitional arrangements Dental nurses & dental technicians Dental nurses & dental technicians Existing qualifications OR Existing qualifications OR Experience & demonstrate competency in 6 areas Experience & demonstrate competency in 6 areas

11. PH & Epidemiology - October 2006 Oral health care in the UK (Daly et al 2002) Public Sector provision (£1674 million/yr) Public Sector provision (£1674 million/yr)  General Dental Services (GDS)  Community Dental Services (CDS)  Hospital Dental Services (HDS)  Personal Dental Services (PDS)  Dental Defence Agency (DDA) Private Sector provision (£926 million/yr) Private Sector provision (£926 million/yr)

12. PH & Epidemiology - October 2006 NHS dentistry facts and figures 21,082 dentists (GDS & PDS) - Sept 2005 21,082 dentists (GDS & PDS) - Sept 2005 GDS GDS  14,377 principals  1,111 assistants  375 VDPs PDS PDS  6,809 dentists  303 VDPs 18.3 million registered adult patients (45%) 18.3 million registered adult patients (45%) 7.3 million registered children (62%) 7.3 million registered children (62%) Dental Practice Board, 2005

13. PH & Epidemiology - October 2006 NHS Services in Medicine and Dentistry MedicineDentistry

14. PH & Epidemiology - October 2006 General Dental Services National contract covering patient registration, dentist remuneration & other procedures National contract covering patient registration, dentist remuneration & other procedures Dentists independent contractors Dentists independent contractors New contract in 1990 - registration and emergency ‘out of hours’ provision New contract in 1990 - registration and emergency ‘out of hours’ provision New contract April 2006 - Units of Dental Activity (UDAs) New contract April 2006 - Units of Dental Activity (UDAs)

15. PH & Epidemiology - October 2006 Working in the GDS Vocational Training Vocational Training Principals, Associates and Assistants Principals, Associates and Assistants Contract with Primary Care Trust (PCT) Contract with Primary Care Trust (PCT) Monitoring through Dental Reference Service Monitoring through Dental Reference Service

16. PH & Epidemiology - October 2006 Community Dental Service Established in 1974 (from local authority) Established in 1974 (from local authority) Salaried service - terms and conditions negotiated nationally Salaried service - terms and conditions negotiated nationally 1700 dentists (1999) 1700 dentists (1999) Contractual arrangements with PCT and Consultant in Dental Public Health Contractual arrangements with PCT and Consultant in Dental Public Health

17. PH & Epidemiology - October 2006 The role of the CDS Treatment of special needs groups Treatment of special needs groups Specialist referral service (GA, ortho) Specialist referral service (GA, ortho) ‘safety net service’ ‘safety net service’ Screening Screening Epidemiology Epidemiology Oral Health Promotion Oral Health Promotion

18. PH & Epidemiology - October 2006 Hospital Dental Service Salaried service Salaried service 2500 dentally qualified personnel 2500 dentally qualified personnel Provision of specialist dental care Provision of specialist dental care Training of undergraduates and postgraduates Training of undergraduates and postgraduates Consultants have parity with medical colleagues Consultants have parity with medical colleagues Contractual arrangements with PCT Contractual arrangements with PCT

19. PH & Epidemiology - October 2006 Personal Dental Services Commenced 1998 Commenced 1998 New ways of providing dental care New ways of providing dental care Pilot sites Pilot sites Three waves Three waves Dental Access Centres (DACs) Dental Access Centres (DACs) Pilot schemes ended when new GDS contract implemented Pilot schemes ended when new GDS contract implemented

20. PH & Epidemiology - October 2006 Recommended reading Essential Dental Public Health. Daly et al. Chapter 19 Essential Dental Public Health. Daly et al. Chapter 19 www.dpb.nhs.uk www.dpb.nhs.uk www.dpb.nhs.uk www.gdc-uk.org/ www.gdc-uk.org/