Chapter 31

UK dental services

GENERAL DENTAL SERVICE

The NHS was set up in 1948 with the aim of providing free medical and dental care for the whole population, regardless of social status. Funded by the government from taxation, it soon became the envy of the world.

Over the years, there have inevitably been many changes to the NHS, including the provision of dental care. Perhaps the most significant change is that adults have had to pay increasing amounts towards the costs of NHS dental treatment. However, pregnant/nursing mothers, children in full-time education and those receiving certain benefits and allowances are still entitled to free dental treatment.

PRIVATE DENTAL PRACTICES

In 1990, the government made radical changes to the way NHS dentists were paid and as a result many dentists left the NHS and adopted private schemes. Such schemes are not liked by all patients, and some private practices still continue to provide free treatment for exempt groups. However, cost is a major factor in discouraging certain population groups from attending.

CLINICAL GOVERNANCE

In 1969, Avedis Donabedian, Professor of Public Health in Michigan, USA, developed a concept for measuring the quality of health care given to patients by professionals, which is regarded by many professionals worldwide as having transformed the way health care was delivered.

Donabedian’s concept was one of the theories which led to clinical governance and quality control in dental practices and trusts: requirements for staff to have appropriate and recognised qualifications, continuing professional development (CPD), and practice inspections to ensure that equipment is up to date and conforms to health and safety regulations.

Clinical governance was introduced to the NHS in 1998 and was designed to bring a systematic approach to the delivery of high-quality health care. Private practices are also required to comply with the requirements of quality control.

The Donabedian concept is based on three principles [1]:

• Structure.
• Process.
• Outcome.

These principles, when applied to providing quality dental care, can be explained as:

• Structure – provision of facilities (e.g. surgery access, equipment), and organisation of the practice (e.g. staff training, qualifications and CPD, patient–staff ratio, personnel attributes).
• Process – what the dentist and team do in the delivery of care for patients, from taking and regularly updating medical histories to the technical process of delivering excellent treatment. Attention to health and safety of patients and staff at all times.
• Outcome – producing evidence that shows that patients are satisfied with the quality of care (e.g. via short questionnaires, when they return for routine check-ups); offering to redo any treatment which has fallen short of patients’ expectations free of charge; developing good relationships with patients so />
  Only gold members can continue reading. Log In or Register to continue