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

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

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

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

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

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

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

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

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

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

  11. Oral health care in the UK (Daly et al 2002) • 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) PH & Epidemiology - October 2006

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

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

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

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

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

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

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

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

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