Justice and NHS dental treatment--is injustice rife in NHS dentistry?

General dental practice and improved oral health: is there a win-win for both the professional establishment and government?

General dental practice in the United Kingdom has been in a state of unrest for over two decades, with practitioners having been confronted by two contract changes. The latest contract change of 2006 resulted in much disquiet, and services continue to be piloted in order to develop a contract that satisfies the needs of both government and the profession. Within this context, this paper explores the issues surrounding the present situation. To date, the profession has expanded service provision into the private market which has resulted in an exaggerated inverse care provision. This could be perceived as a move towards a retail philosophy and away from healthcare. In order to restore an equitable balance of care provision, the authors present possible solutions that could satisfy both parties.

Flipping the grant application review process

The return on research investment resulting from new breakthrough scientific discoveries may be decreasing over time due to the law of diminishing returns, the relative decrease of research funding in terms of purchasing power parity, and various activities gaming the system. By altering the grant-review process, the scientific community may directly address the third problem. There is evidence that peer reviews of research proposals may lack reliability and may produce invalid or inconsistent ratings. In addition, extreme focus on grantsmanship threatens to uproot a cornerstone principle that scientific-value should be the key driver in funding decision-making. This opinion provides (1) a justification of the need to consider alternative strategies to boost the impact of public investment in innovative scientific discovery, (2) proposes a framework for flipping the traditional front-loaded peer-review approach to allocation of research funding, into a new back-loaded assessment of scholarly return on investment, and (3) provokes the scientific community to accelerate the debate on alternative funding mechanisms, as the stakes of inaction may be very high.

Assistência odontológica em programas sociais para populações socialmente vulneráveis na perspectiva do programa Uruguay Trabaja

Resumo Este trabalho discute características do subprograma da saúde bucal do programa Uruguai Trabaja (UT), em Montevidéu, e identifica os tratamentos odontológicos iniciados, completados e abandonados de 2008 a 2015. Por meio de análise documental, o UT é discutido a partir de dois níveis categóricos. O primeiro refere-se ao contexto macrossocial, relacionando-se à expansão da cobertura da assistência odontológica integrada nos sistemas de proteção social, enquanto o segundo se origina da observação sistemática da assistência odontológica inserida em programas de acompanhamento social. UT é um programa social anual de nove meses de duração dirigido a pessoas de 18 a 65 anos em situação de vulnerabilidade socioeconômica e desempregadas há muito tempo. Seu propósito é melhorar a empregabilidade e a integração social dos participantes. Assistência odontológica integral é um dos benefícios do programa, a qual não é disponibilizada pelo Sistema Nacional Integrado de Saúde. Dos 2.592 tratamentos odontológicos iniciados, 941 (36,3%) não chegaram ao final. Programas focalizados como o UT, enquanto dispositivos de proteção social, devem estar articulados funcionalmente a políticas sociais universais que devem responder adequadamente as necessidades da população. A saúde bucal, nesse contexto, deve ser incluída no Sistema Nacional Integrado de Saúde do Uruguai, garantindo o direito à saúde.

Are clinical decisions in endodontics influenced by the patient's fee-paying status?

OBJECTIVE

We explored whether the fee status of a UK patient influences clinical decision-making in endodontics.

SUBJECTS AND METHODS

In a randomised-controlled vignette study describing either an 'NHS-funded', 'Privately-funded' or undisclosed fee-status patient, we examined the importance vocational trainer dentists placed on a series of factors normally considered when deciding whether to offer patients endodontic treatment as opposed to extracting the tooth. N = 119 experienced (M years post qualification = 20.01) dentists participated.

MAIN OUTCOME MEASURES

Having read a vignette describing a hypothetical patient who could potentially be treated either endodontically or through an extraction, dentists rated a series of factors they would normally consider (for example, poor oral hygiene, the rest of their mouth is unfilled and caries-free), before recommending either endodontic treatment or an extraction.

RESULTS

The patient's funding status had no influence on these dentists' clinical decision-making when considering endodontic treatment as an option (p >0.05) with the exception of a single item relating to infrequent attendance where the NHS patient was more likely than the 'undisclosed-fee' patient, to be offered extractions (F (2, 116) 3.43, p <0.04).

CONCLUSIONS

We have found no strong evidence to suggest that the fee-status of a patient influences clinical decision-making in endodontic treatment by experienced dentists.