OFT review of the dental market 2012
On 29 May 2012 the Office of Fair Trading published its report into the dental market. The report and the accompanying press release can be found on its website.
The report’s main conclusions are:
Barrier to entry to the market
The NHS dental contract in England acts as a barrier to entry, expansion and innovation in the dentistry market. By this OFT means that contracts should be time-limited (as opposed to open-ended which insulates practices from competition and drives up the price (goodwill value) of dental practices and instead should be opened up, by 2014 or the introduction of a new contract, to regular competition under the ‘any qualified provider’ principle, with the payment following the patient. This will also drive up efficiency and quality.
The NHS Commissioning Board has agreed to implement a more streamlined procurement process for England.
Direct access to Dental Care Professionals
The public should be able to access dental care professionals directly, rather than by referral from a dentist. It calls on the General Dental Council to act swiftly to lift the current restrictions urgently and is perturbed that similar recommendations it made in its 2003 study have not yet been acted upon by the GDC. The benefits it sees are: greater patient choice and access to treatment; greater competition, driving up quality, range of services and value for money; more efficient use of resources; and the development of new models of service. OFT says: ‘There is a broad consensus among the many academic dental experts with whom the OFT has discussed this issue that dental hygienists and dental therapists are entirely adequately trained to screen (but not diagnose) patients for oral disease and to make the appropriate referral’. GDC currently has a working group looking at direct access and OFT will closely monitor its progress and, if it does not decide restrictions by spring 2013 to lift the, OFT will consider referring the matter to the Competition Commission.
Provision of information
Patients are not given enough information to make active, informed decisions about their choice of dentist, treatment and cost and are less able to shop around. OFT castigates the GDC and NHS commissioning bodies for failing to be proactive in enforcing current rules and guidance and recommends that they take more timely enforcement action.
It suggests greater exploitation of NHS Choices in England and similar methods in Scotland, Wales and Northern Ireland and urges the Care Quality Commission and other, equivalent inspecting organisations to include provision of information in their inspections. The Chief Dental Officer in Scotland has agreed to explore whether Dental Reference Officers could be tasked with exploring these issues and the Scottish Government is urged to expedite its consideration of how to regulate independent health care services and ensure that the regulator prioritises ensuring that Scottish dental patients are provided with written treatment plans in advance of receiving dental treatment.
Urgent action should be taken by NHS commissioning bodies to ensure that patients have accurate information on their entitlement to NHS treatment, by the use of remedial notices, withholding or deducting monies and where appropriate termination of an NHS contract. The GDC should take more prompt, regular and robust disciplinary action in cases where patients are misled. Where such bodies have not taken action, OFT and Trading Standards Services can step in under consumer protection law.
All NHS commissioning bodies should take timely and robust enforcement action to ensure that practices provide a treatment plan and treatment cost at the time of the initial check-up.
The BDA is asked to develop a ‘robust and effective code of practice to help ensure that dentists do not engage in ‘pressure selling’ of dental payment plans and thereby run the risk of non-compliance with consumer protection law’. The GDC is urged to take enforcement action against pressure selling.
There should be a mandatory requirement for dental practices to make easily available the private prices for exams and scales and polishes and minimum and maximum prices for a range of other common treatments. OFT believes that failure to provide timely price information is widespread and prevents, restricts or distorts competition. It seeks views on whether or not the matter should be referred to the Competition Commission. Agreement has been reached with IDH and Oasis to make private price lists available and the National Commissioning Board in England has agreed proactively to monitor practices’ compliance with the requirement to display NHS charges, through the addition of relevant questions to the GP Patient Survey.
Patients should be able to compare quality. The Department of Health and the NHS Business Services Authority in England have agreed to publish the results of NHS patient surveys and measures of patient satisfaction with dental practices on NHS Choices and OFT urges similar measures elsewhere. It recommends that DH publishes summary scores of individual dental practices’ clinical effectiveness, patient experience and safety as measured in the Dental Quality and Outcomes Framework currently being piloted in England.
Complaints processes should be simplified, with a single portal to triage complaints to the appropriate body. OFT will work with organisations such as Which?, Citizens Advice and NHS Choices (and devolved nation equivalents) to develop and disseminate patient education materials to improve awareness and understanding of their rights to redress and how to complain.
A one-year guarantee should be provided for private treatment and included in the GDC’s Standards for Dental Professionals. IDH and Oasis have agreed to do so.
Competition Commission referral
OFT concludes that a number of aspects of the dental market fulfil the ‘reference test’: failure to display NHS treatment prices and to make available private prices; barriers to entry to the NHS market in England; and restrictions on access to DCPs. It does not consider that a reference would be appropriate at the moment as steps are being taken by the responsible organisations to address the aspects and it will closely monitor their progress. It is consulting on this decision, with a closing date for submissions of 10 July.
The BDA has been standing up for the profession in the national and local media following the report's publication.