Synopsis of the 2016 Malcolm Pendlebury Memorial Lecture

The following is a synopsis of the Malcolm Pendlebury Memorial Lecture, delivered by the Chief Dental Officer for England, Sara Hurley, to the Faculty of General Dental Practice (UK) on 26 February 2016. It is not a verbatim transcript, but aims to cover the main points of the lecture, notably the key themes of the emerging oral health and dental care strategy, as proposed and described by the CDO.

What do we mean by strategy? A term often used incorrectly to describe policy, but actually the necessary pre-requisite to any policy; a synthesis of all the ideas, interests and ideologies at our disposal; the ‘art of the possible’ if you will.

However, in grasping the various legacy and more contemporary issues to develop a set of solutions, and turn strategic concept into reality, the Office of CDO is engaged in an iterative dialogue with all our stakeholders, including the patient population. Fortunately the ‘tricorn’ nature of the CDO portfolio enables a very positive relationship between strategy, policymakers and the commissioners, as well as those at the delivery interface.

So in being transparent about the art of the possible, and our areas for development and quality improvement, we can perhaps shift the agenda towards more joint endeavours - professional, geographic and conceptual.

As part of this shift, NHS England has acknowledged our observations that there are inconsistencies in the processes operated by the different Local Offices, which has resulted in either over-regulation, or at the other end of the scale an inability to monitor, identify and address potential performance issues. I am sensing an appreciation for the benefits of greater national direction over the responsibilities of the Local Offices, complemented by a desire for training to support and develop the nascent qualities in the commissioning teams.

I think we all recognise that our commissioning colleagues would value a joint sense of ownership of the health outcomes, as opposed to just being responsible for the purse strings.

So based on these findings, the Office of CDO continues to advise of the need for clinically-led dental commissioning, and a re-design of the NHS England groups required to assess local need, and design and manage the services in their area. This re-design is the CDO Executive’s top priority for the year.

Another strategic task for the Office of CDO is to ensure that all NHS England Commissioners know what quality oral care looks like - both as a long-term investment in the population’s health, and as a short-term response to an individual’s immediate health need.

This theme recurs throughout the new guides for the commissioning of dental specialties, with the recognition that there are a range of patients and an equally complex range of oral health needs.

Many of the care pathways outlined in the guides will call upon the skills of specialists or Consultants, who may be operating in either primary care or secondary care settings.

However, the guides recognise that many General Dental Practitioners develop interests, skills and competence with increasing years in practice, and that these experienced GDPs are very capable of confidently and competently handling level 2 complexity case loads. NHS England desires to use the skills of these individuals, and the detail of how to validate and contract these highly skilled individuals is vital on-going work.

Complementary to this, we are moving ahead with the development of Managed Clinical Networks, and empowering the Local Professional Networks.

The readiness and willingness of all these skilled providers are essential if we are to future-proof NHS England in preparation for contract reform - I could not complete a presentation without mentioning contract reform, a critical activity if we are to make the transition from dental activity to oral health the desired outcome of the NHS dental service.  

Much NHS dentistry is already outstanding, reflecting the quality of the workforce, but the current UDA contract limits practice to a reactive model of care.  We all wish to embrace the prevention approach. The basic structures that we have in place are transformable, but continue to require tangible ambition if we are to make the necessary changes and move on to the next, and most challenging, stage.

The advent of the Prototypes is this next step, but not the last step. Our aspiration is for the Office of CDO to be the “governor” of the strategic architecture of contract reform - the critical friend to DH in evaluating the Prototypes - and to work closely with DH to shape and align legislation and regulation, if we are to optimise contracting for prevention. 

It was an honour to be invited to deliver the fifth Malcolm Pendlebury Memorial Lecture. During his tenure as the third Dean, Malcolm assured the Faculty’s position as a permanent member in our family of UK dental institutions. The continued achievements of the Faculty’s members, as custodians of the standards that set apart the extraordinary from the ordinary, and its well-deserved reputation for innovation in the pursuit of quality improvement, stand testament to his leadership. It remains our duty to continue to bring Malcolm’s energy and commitment to the work that we do in developing excellence throughout primary dental care as the norm.

As we move forward with our integrated oral health and dental care strategy, the support and leadership of the Faculty of General Dental Practice (UK) remains an enduring requirement, and a commitment which I am sure Malcolm Pendlebury would be proud to honour. 

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