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April 1-7, 20138 Review United Kingdom Edition T he framework neces- sary to underpin the commissioning of den- tal services is not yet in place for all specialities just weeks before the NHS Commission- ing Board(NCB) is set to come into force, warned Kathy Harley, Dean of the Faculty, speaking to the Dental Law and Ethics Forum on March 13th. Immediate challenge The timeframe for the changes to commissioning of NHS den- tal services has been difficult for all those working within the Commissioning Board, and there is an acceptance that services cannot change overnight. The immediate challenge, said Miss Harley, will be to achieve a safe trans- fer of all dental services from Primary Care Trusts to the NHS Commissioning Board. The Dental Faculty of the Royal College of Surgeons of England welcomes its in- volvement in the develop- ment of the Care Pathways which are being developed by the Commissioning Board to assist in the local commis- sioning of services. However, Miss Harley expressed con- cern that Care Pathways for only two dental specialities, Paediatric Dentistry and Oral Surgery, were complete. Work is currently underway on the development of the Periodon- tology Care Pathway and will eventually be developed for each dental speciality with the aim of achieving continuity of care. Miss Harley explained the new structures and the need to develop a workforce who could be readily identified as capable of providing “en- hanced” skills. She explained that three levels of care pro- viders had been created: GDPs were considered to be Level one, Specialists/Consultants Level three and a new group- ing at Level two equate to practitioners with ‘enhanced’ skills. A series of clinical skills which an enhanced practi- tioner would be expected to provide have been defined, and the Faculty is developing an assessment/assessments which will allow for these clinical competences to be appropriately evaluated. This will enable commissioners to identify those practitioners who have the additional skills necessary to deliver a Level two contract. Consistency In order for consistency and continuity of care across the whole of England, it is impor- tant to develop an appropri- ate training pathway and as- sessment recognisable by all. This will facilitate the NCB, Area Teams and Local Dental Networks to establish a new architecture and framework with the development of sin- gle operating procedures and policies. The Faculty has set up a group to take this work for- ward accepting that there is much to be done in a very tight schedule. Aware that training is already underway in a num- ber of Deaneries, Miss Harley expressed the desire to en- sure that there is consistency across the Deaneries and the need to prevent widely differ- ing training schemes and as- sessments being developed to achieve the same outcome. Miss Harley’s second topic was the change in European regulations on bleaching and the concern that this proce- dure might now be prohibited for under 18s. Using some of her own material - she works as a consultant in Paediatric dentistry - she showed her audience the highly pleas- ing treatment undertaken on teenagers which could now be considered “illegal”. Many of her patients had enamel blemishes affecting their front teeth as a consequence of a childhood illness, eg chicken pox, inherited disorder or trauma to the primary pre- decessor. Effective manage- ment of the enamel blemishes can be achieved with bleach- ing which avoids the need for more invasive treatment. Resolving confusion Dialogue is currently under- way, she said, between the Department of Health, GDC and other interested bodies to resolve the confusion in this area as this deserving group of patients should not be man- aged with destructive removal of enamel and the provision of veneers and crowns to im- prove the appearance of their teeth. Likewise children who have discoloured incisors fol- lowing an earlier incidence of trauma, who for years have been managed by bleaching, should not be excluded. For more information about the Dental Law And Ethics Forum, visit the web- site: DT Challenging times ahead as NHS Commissioning Board succeeds PCTs A report from the recent Dental Law and Ethics Forum meeting Practices are still awaiting the framework necessary for the commissions of services ‘The timeframe for the changes to commis- sioning of NHS dental services has been difficult for all those working within the Commissioning Board’