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Complexities associated with orthodontic services in the National Health Service
1Cardiff University, Applied Clinical Research and Public Health, Cardiff Dental School, University Dental Hospital, Heath Park, Cardiff CF14 4XY.
Aim:
To detail orthodontic provision in Wales.
Background:
In 2006 the new orthodontic contract was introduced in the NHS in England and Wales. Since the introduction of the new contract there have been recent reports of inefficiencies in orthodontic provision in Wales in terms of: orthodontic provision reaching those who need it, type of orthodontic activities undertaken, who is providing orthodontic care, the relative cost-efficiency of the orthodontic services, contracting and performance management of the services and robustness of the orthodontic database.
Materials And Methods:
2008/09 orthodontic data on contracted services were analysed. Data from the salaried services was collected through a questionnaire. Normative orthodontic treatment need was estimated from mid-year population estimates.
Results:
In 2008/09, there were considerable inefficiencies in the orthodontic services in Wales with varied level of access by children living in 22 former local health boards, co-terminus with local authorities in Wales. Total spend on orthodontics in Wales was around £12,718,370. It was estimated that 11,539 (30%) of 12-17-year-olds required orthodontic treatment. In 2008/09, 11,031 children received orthodontic treatment in all NHS services in Wales indicating a potential shortfall of 508 treatments. Out of 135 GDS/PDS orthodontic contracts, 27 provided no active treatment (only assessments) and 62 provided less than 50 treatments annually. Cost per units of orthodontic activity (UOA) ranged from £58 to £74. With improved contracts and efficiency, the orthodontic budget seems sufficient to meet the orthodontic need of the population.
Conclusions:
As with any type of NHS provision, it is important that orthodontic services are competitive, highly efficient and provided on the basis of need. Performance management of orthodontic services should focus on the number of successful orthodontic treatments delivered annually. The personal dental services (PDS) orthodontic contract will need to be modified accordingly.
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