25 Sep 2015  •  Options Out Of The NHS  •  3min read

Rubik’s NHS Blog No.3

In previous blogs I’ve drawn a comparison between trying to design the next English NHS dental contract and solving a Rubik’s Cube – as fast as you get one part sorted, you realise that, in the process, you’ve inadvertently messed up another part!

In my last offering, I spoke about how the pilots had highlighted the challenge of finding the right mix of financial incentives that could satisfy patients, dentists and Government. The new care pathway and oral health assessment were largely well received by dentists and patients but not by Government due to the reduced patient throughout, and by implication, access, in the pilot practices.

Access to NHS care has been a major complaint from the general population, so has consequently been a priority for successive Governments. It should, therefore, not be a surprise that the prototype stage of the contract reforms seeks to redress the balance by incentivising the maintenance of patient numbers in NHS practices. The pressure this recreates could then, in turn, reduce the benefits in the pathway approach felt by dental teams.

And there is a specific and important consideration related to this point. Recent research by various organisations, including the BDA, has pointed to the stress levels and general poor morale of the dental profession. There appears to be a number of factors creating this situation of which the fear and reality of patient complaints and associated litigation is one of the more significant.

As I’ve heard Kevin Lewis, amongst others, emphasise on many, many occasions, the majority of complaints have their origins in breakdowns in communication. And I’ve also heard it repeatedly said, that good, effective communication is more easily achieved with enough time. It’s not dependent on enough time, as you can give a poor communicator all the time in the world and there may still be an issue, but its common sense that rushing communication, as can so easily happen in a very busy practice, risks more issues arising in the future.

I’ve not seen the stats relating to patient complaints in the pilot practice but it was clear that most patients responded positively to the longer duration of the oral health assessment and patient satisfaction with the pathway approach, as conducted in the pilots, was high. It therefore seems logical to speculate that with higher patient satisfaction and greater time for effective communication, the risk of patient complaints at a practice level was reduced.

So the mischievous Rubik’s Cube comparison is to speculate that Government, in seeking to reduce complaints about access at a general public level for which it receives criticism, is increasing complaints at an individual patient level for which practice owners receive criticism (and stress and financial penalty). Hmmm!

You can read part one of Nigel’s Rubik’s NHS series here

Part two can be found here

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