NHS reform and NHS England
NHS England (previously the NHS Commissioning Board) assumed
responsibilty from PCTs and SHAs on 1 April 2013 which were abolished
on 31 March 2013. NHS England now has responsibility for the
commissioning of all primary care which includes all areas of
Although many of the changes will have an impact on
dentistry and the way in which it is provided in England, the move of
responsibility for contract management and the provision of services
from local primary care organisations to NHS England is likely to have
the most immediate impact.
In February 2013, NHS England published Securing excellence in commissioning NHS dental services which is a single operating framework for NHS dentistry. The BDA webpageoutlines the impacts of this framework for NHS dentistry and how services will be commissioned.
For quick reference, a summary of some of the key changes to the NHS is described below. Some extra information and background information is contained within the 2012 policy brief on the reforms.
What do we know?
NHS England will have 27 Area Teams (ATs)
Each will have multiple office locations so their footprint will be greater than 27
will lead on specialist commissioning across England and a smaller
number will carry out direct commissioning of other services such as
military and offender health.
They will manage 38,000 contracts.
role in commissioning dental services will be similar to that currently
undertaken by the clusters with one key difference: they will work to
central policy and consistent guidelines. GDS and PDS contract
management arrangements will follow common national processes.
Local professional input and responsibility
has been proposed that Local Professional Networks (LPNs) – and Local
Dental Networks (LDNs) specifically – clinically lead and own the
quality and performance improvement and assurance
local implementation of NHS England strategy
planning and designing local care pathways and services
oral health strategy and improvement
clinical and professional leadership and engagement
will work closely with local Health and Wellbeing Boards (HWBs) to
inform the Joint Strategic Needs Assessments (JSNAs). The needs
assessments will turn into the Joint Health and Wellbeing Strategy
(JHWS) which will outline how NHS England will ensure that the needs of
their local populations are met.
They will form relationships with
the 14 Local Education and Training Boards (LETBs), part of Health
Education England (HEE) which is the organisation tasked with funding
and coordinating health education and training. The BDA is represented
on HEE’s Dental Programme Board.
The Deaneries are taking a lead
on ensuring adequate dental representation is included within the LETBs
and it looks likely that the function of the Deaneries will continue.
Dental Networks will be expected to work with Local Dental Committees
(LDCs) to ensure that there is engagement with the profession locally.
will be 12 Clinical Senates across England. Their role will be to bring
clinical leaders together to enable cross-specialty collaboration,
strategic advice and innovation to support commissioners. They will help
CCGs, HWBs and NHS England to make the best decisions about healthcare
for the populations they represent by providing advice and leadership at
a strategic level.
History of NHS reform
Talk of reforming the NHS began when the Government published the White Paper, Equity and excellence: Liberating the NHS,
on 12 July 2010. The BDA discussed the proposals contained within the
White Paper with parliamentarians and civil servants within the
Department of Health.
Following discussions with the Department of
Health and other civil servants, the BDA prepared its response to the
White Paper consultations. One of the key messages within the White
Papers that we were enthusiastic about was the move towards a
centralised commissioning system, which had the potential to unpick some
of the many inconsistencies across England with regard to contract
management and NHS commissioning processes.
The BDA responses to
the consultations from the Government about changes to the NHS are
available by following the links on the left hand side of the screen.