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Implementing local commissioning for dentistry
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Last modified date:25 April 2008
Since 1 April 2006, primary care trusts have had responsibility for commissioning primary dental services to reflect local needs and priorities. This includes agreeing and monitoring local contracts with dentists or corporate bodies for the delivery of primary dental services.
This means that primary care trusts now have an integrated responsibility for commissioning both general dental care and more specialist dental care, regardless of whether it is provided in general practice, in community-based salaried services, or in hospitals.
These pages contain more information about:
- the different types of general and specialist dental services delivered across primary and secondary care
- the guidance and support available to primary care trusts and the professions in relation to commissioning dental services
- financial allocations for primary care dentistry
- the development of salaried primary dental care services
- dentists with a special Interest.
General and specialist dental services
The term ‘primary dental care’ refers to the work undertaken by dentists and other dental care professionals (hygienists, therapists, nurses and technicians) both in general practice and (to a lesser extent) in community services run directly by PCTs or other NHS organisations. Primary dental care encompasses the main dental care and treatment needed to maintain good oral health. This includes providing treatments such as fillings and extractions, as well as fitting bridges and dentures, and advice on how to look after teeth and gums in order to prevent oral health problems occurring.
Primary dental care can also include more specialist services, such as orthodontics (straightening teeth), minor oral surgery, domiciliary care, and sedation (easing anxiety). These services are usually provided by referral to another general dental practitioner or to a Dentist with Special Interests.
Most primary dental care is provided by self-employed dentists or corporate bodies that hold contracts with the NHS. These practices typically provide a mixture of NHS and private care.
PCTs and some other NHS organisations also provide salaried primary dental care services, both to provide specialised care for particular groups (such as patients with physical or learning disabilities) and – in some cases – to supplement the general dental services provided in general practice.
The term ‘secondary dental care’ refers to more specialised services provided in hospitals. This includes oral surgery, specialist orthodontics and more complicated root canal and bridge work.
Some services traditionally provided within hospitals are, however, likely to be increasingly provided by Dentists with Special Interest or other dentists in primary care. This is increasingly breaking down the traditional distinctions between primary and secondary care.
Commissioning dental services: guidance and support for PCTs
The Primary Care Contracting website contains a wide range of guidance, toolkits and good practice examples to support primary care trusts in commissioning dental services.
The following documents contain all the main guidance published by the Department of Health on the implementation of the dental reforms, including guidance on:
- agreeing contracts with dentists
- PCT dentistry budgets and patient charges
- dental vocational training
- commissioning out-of-hours services
- commissioning orthodontic services
- referrals to other practitioners.
- 25 April 2008: Revised guidance: primary care dental contracts Advice on managing end of year issues
- 16 January 2008: Commissioning NHS primary care dental services: meeting the NHS operating framework objectives
- 4 June 2007: Commissioning conscious sedation services in primary dental care - revised guidance
- 24 May 2007: Primary care dental services: guidance on single-use instruments for endodontic procedures
- 3 April 2007: This letter from the Chief Dental Officer to primary care trust chief executives outlines the legal requirements with regard to dental surveys and their importance in the local commissioning of dental services
- 24 January 2007 : Primary care dental contracts: Advice on managing end-year issues
- 19 January 2007: Dental screening (inspection) in schools and consent for undertaking screening and epidemiological surveys
- 7 December 2006: Primary care dental services: data validation changes
- Implementing local commissioning for primary care dentistry - factsheets
- 21 September 2006: Strategic commissioning of primary care orthodontic services
- Download FAQs on the new contract - 2 June 2006 (PDF, 42K)
- Commissioning specialist dental services guidance - December 2005
Financial allocations for primary care dentistry
Primary care trusts now hold devolved revenue budgets for commissioning primary dental services. It is anticipated that primary care trusts will spend some £2.4 billion on primary dental services in 2006/07, including some £600 million raised from patient charges. The net value of PCTs’ dental budgets (after taking into account anticipated patient charge revenue) is some £1.7 billion.
In May 2006, the Department announced a capital investment programme of £100 million over two years to support PCTs and dental practices in improving services for patients.
The Department also allocates funding to strategic health authorities to meet the costs incurred in the system of vocational training for dentists who have completed their undergraduate training.
The paper on patient charge revenue sets out:
- the main factors that may account for the lower than expected dental patient charge revenue (PCR) being reported for some areas
- possible action for PCTs to consider to reduce risks to PCR
- the support available from the NHS Business Services Authority (BSA) and NHS Dentistry Support Team.
Developing salaried primary dental care services
In March 2006, the Department announced steps to take forward modernisation of salaried primary dental care services, following a wide-ranging review and consultation. There was overwhelming support in the consultation for continuing with a salaried option for dentists working in primary care and for developing a new pay spine for salaried generalists. The Department has invited NHS Employers and the British Dental Association to negotiate new pay arrangements for salaried dentists that will support the conclusions of the review and consultation.
The PCT Dental Services Directions 2006, which came into force on 1 April 2006, provide a common and consistent framework for future provision for salaried primary dental care services.
- 31 March 2006: National Health Service Act 1977: Primary Care Trust Dental Services Directions 2006
- Download factsheet on salaried primary dental care services: 30 March 2006 (PDF, 83K)
- 14 March 2006: Creating the future: modernising careers for salaried dentists in primary care - report and CDO letter
Dentists with a Special Interest
The framework for accrediting and appointing Dentists with Special Interests gives PCTs additional flexibility in deciding how to commission specialist dental services such as orthodontics, endodontics, periodontics and minor oral surgery.
Additional links
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NHS dental services
Reforms introduced in April 2006 are designed to help provide better access to dental services and simplify the system of patient charges.
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