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NHS reform

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 dentistry. 

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?

How will the NHS changes impact on day to day dental practice?

NHS England will have 27 Area Teams (ATs)
  • 9 in the North

  • 8 in the Midlands and East

  • 7 in the South

  • 3 in London

Each will have multiple office locations so their footprint will be greater than 27

Functions include:
  • development and assurance of Clinical Commissioning Groups (CCGs)

  • emergency planning

  • resilience and response

  • quality and safety

  • partnerships

  • configuration

  • system oversight

10 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.

Their 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

It has been proposed that Local Professional Networks (LPNs) – and Local Dental Networks (LDNs) specifically – clinically lead and own the delivery of:

  • 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

They 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.

Local Dental Networks will be expected to work with Local Dental Committees (LDCs) to ensure that there is engagement with the profession locally.

There 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.




NHS reform in England (296.69 KB)