Rise In NHS Dental Tooth Extractions And Dentures, But Fall In Fillings And Crowns, UK

Main Category: Dentistry
Article Date: 25 Aug 2008 - 0:00 PDT

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A patient undergoing NHS dental treatment under the new contractual arrangements is more likely to have dentures or tooth extractions and less likely to have fillings or crowns than under the old arrangements, a report released by The NHS Information Centre (The NHS IC) suggests.

The report, Dental Treatment Band Analysis: England and Wales, 2007/08, considered nearly 10,000 adult dental Courses of Treatment (CoTs) in England and nearly 1,500 adult CoTs in Wales.

It suggests that in England, the percentage of Band 35 CoTs including dentures increased from 38.1 per cent in 2003/04 to 47.9 per cent in 2007/08, while the overall percentage of CoTs including an extraction increased from 6.9 to 7.9 per cent. In Wales, the percentage of CoTs with extractions increased from 7.8 to 9.3 per cent from 2003/04 to 2007/08, while there was no significant change with dentures.

The percentage of Band 3 CoTs in England including a crown fell from 47.8 per cent in 2003/04 to 35.3 per cent in 2007/08. During the same period in Wales, the percentage of Band 3 CoTs including a crown fell from 44.3 to 35.1 per cent.

In England, there has been a reduction in the percentage of CoTs including a filling from 28.3 per cent to 26.0 per cent, and the average number of fillings in CoTs with fillings has reduced from 1.8 to 1.4.

The report is published alongside two further reports from The NHS IC: NHS Dental Statistics for England: 2007/08, and Dental Working Hours: England and Wales, 2006/07 and 2007/08.

Key findings from NHS Dental Statistics for England: 2007/08 show:

- In England there were 36 million CoTs in 2007/08, a 2.7 percent rise (937,000) on the previous year. During the same period the number of Units of Dental Activity (UDAs) carried out increased by 4.5 per cent (3.3 million) to 77 million.

- There were 20,815 dentists with NHS activity during 2007/08 - an increase of 655 dentists (3.2 per cent) on 2006/07, the first year of the new dental contract system. This is due to a higher number of dentists joining the NHS in 2007/08 (1,709) compared to the number who left in 2006/07(1,054).

- A total of 27 million patients (53.3 per cent of the population) were seen in England in the 24 month period ending 31 March 2008, a decrease of 3.9 per cent (1.1 million) on the 24 month period ending 31 March 2006.

- £531.4 million was calculated as patient charge revenue for treatments completed in 2007/08, an increase of £56.0 million (11.8 per cent) on the previous year.

Key findings from Dental Working Hours: England and Wales, 2006/07 and 2007/08, based on more than 10,000 survey responses in England and Wales, show that in 2007/08:

- NHS dentists (full and part time) reported working an average of 37.0 hours per week in dentistry, of which 26.2 hours were devoted to the NHS. Overall, dentists reported 84.8 per cent of their time was spent on clinical work, while 15.2 per cent was spent on administrative work.

- Male dentists worked more weekly hours on average than female dentists - 39.5 hours compared to 32.6 hours. However, female dentists spent more of their time working in NHS dentistry - 74.9 per cent compared to 68.9 per cent for male dentists.

- The proportion of total time spent on NHS dentistry varied by region, with figures ranging from 56.2 per cent in the South Central Strategic Health Authority (SHA) to 83.6 per cent in the North East SHA.

Tim Straughan, Chief Executive of The NHS Information Centre said: "These reports show the most comprehensive picture of NHS dentistry to date under the new contractual arrangements. As a qualified dentist myself, it is interesting to see how a typical course of dental treatment is changing."

Full copies of the reports are at:

NHS Dental Statistics for England: 2007/08: http://www.ic.nhs.uk/pubs/dental0708

Dental Treatment Band Analysis: England and Wales, 2007/08: http://www.ic.nhs.uk/pubs/dentaltba0708

Dental Working Hours, England and Wales, 2006/07 and 2007/08: http://www.ic.nhs.uk/pubs/dentalworkinghours0708

1. The NHS Information Centre is England's authoritative, independent source of health and social care information. It works with more than 300 health and social care providers nationwide to provide the facts and figures that help the NHS and social services run effectively. Its role is to collect data, analyse it and convert it into useful information which helps providers improve their services and supports academics, researchers, regulators and policymakers in their work.

2. The NHS Information Centre also produces a wide range of statistical publications each year across a number of areas including: primary care, health and lifestyles, screening, hospital care, population and geography, social care and workforce and pay statistics.

3. The reports 'Dental Treatment Band Analysis: England and Wales, 2007/08' and 'Dental Working Hours: England and Wales, 2006/07 and 2007/08' have been produced by the NHS Information Centre through joint working group with a number of key stakeholder organisations, including representation from the Department of Health (DH), the British Dental Association (BDA), the secretariat for the Review Body on Doctors' and Dentists' Remuneration (DDRB), the Welsh Assembly Government (WAG), and the Dental Services Division (DSD) of the NHS Business Services Authority (NHSBSA).

4. Regional information is available for NHS Dental Statistics for England: 2007/08 (which includes an electronic fact sheet tool giving detailed PCT and SHA breakdowns) and Dental Working Hours: England and Wales, 2006/07 and 2007/08. 'The Dental Services Division (DSD) of the BSA has recently issued PCT level patients seen nformation for management information purposes. PCTs have recently raised some issues which suggest that the way in which patients are allocated to PCTs across the various quarters needs to be reviewed. This means that sub-national information on patients seen has not been published in this report. The DSD has confirmed that this issue could only have a minimal impact on the national figures. They have therefore been labelled as provisional pending the review. Further information on this review will be available in due course.

5. The year 2003/04 was chosen for comparison for Dental Treatment Band Analysis: England and Wales, 2007/08 because it was last period in which financial processes and patient care were stable before the majority of the transfer from General Dental Services (GDS) to Personal Dental Services (PDS) from 2004/05 to 2005/06. This was then followed by fundamental reforms to the dental system in April 2006. This report provides information on NHS dental activity within a sample of adult Courses of Treatment (CoTs). Information was taken from a sample of 9,822 CoTs in England and 1,446 CoTs in Wales, processed between April 2007 and March 2008, covering dental contracts across all Primary Care Trusts in England and Local Health Boards in Wales.

6. All changes quoted for treatments are significant changes across all CoTs; where Band 3 is mentioned, it is because these treatments (i.e. dentures and crowns) occur only within Band 3 CoTs.

7. The new contractual arrangements introduced a simplified system for paying dentists. Before, dentists were paid for individual treatment items. Under the new system, they are now paid for an entire course of treatment (CoT). Courses of Treatment fall into three main bands (based on the complexity of the most complex aspect of the treatment). Band 1 covers a check up and simple treatment (such as examination, diagnosis (e.g. x-rays), advice on preventative measures, and a scale and polish), Band 2 includes further mid range treatments (such as fillings, extractions, and root canal work) in addition to Band 1 work, and Band 3 includes further complex treatments (such as crowns, dentures, and bridges) in addition to Band 1 and Band 2 work. Treatments in Bands 1 to 3 attract a patient charge.

There is also a separate Urgent Band which include a specified set of possible treatments provided to a patient in circumstances where:

- Prompt care and treatment is provided because, in the opinion of the dental practitioner, that person's oral health is likely to deteriorate significantly, or the person is in severe pain by reason of their oral condition; and

- Care and treatment is provided only to the extent that it is necessary to prevent that significant deterioration or address that severe pain.

8. Information on the number of dentists is provided by contract type, dentist type, gender, and age group. Information on joiners and leavers is also included. Due to the revised methodology, these figures supersede the workforce figures provided in 2006/07 and are not comparable with previously published figures under the old contract system.

9. A 2000 survey by BMRB (The British Market Research Bureau) for the Review Body on Doctors' and Dentists' Remuneration looked at dentists working in the General Dental Service in Britain. It showed that both full and part time dentists worked an average of 39.4 hours per week in 2000.

http://www.ic.nhs.uk