A widget might be worth it
It’s only right that payment reform has time to bed in – but urgent consideration should be given to a potentially lifesaving amendment
At the 2023 Scottish Dental Show a delegate asked Professor Jason Leitch, Scotland’s National Clinical Director, a question about oral cancer. It came during a discussion around the development of a new model of care in Scotland. At that point in time, the Scottish Government was still working on its reform of the system of payment for NHS dentistry.
Asked about work on the new model, Professor Leitch said: “The trick is to find a formula, a funding mechanism, that will reward people doing it for a living and that doesn’t result in either over-treatment or under-treatment. If you pay ‘per widget’, the danger is that you get too many widgets. If you pay for just caring, you don’t get any widgets.”
The question that subsequently came was about the possibility of a payment for oral cancer screening of NHS patients – who would not have to be registered with a practice to undergo the process – with the delegate adding: “I’m terrified of all the patients we have not seen, and I think payment for occasional oral cancer screening would make a world of difference.”
Given the devastating toll wrought by oral cancer the question of a specific payment for oral cancer screening of NHS patients should be revisited, urgently.
The National Clinical Director responded: “Your fundamental point is correct; that in the present climate we can’t do all the treatments that a cohort requires so we should prioritise what is required – and that might be cancer screening. I’m just not sure your route to it is entirely correct; a system of payment could be open to abuse.” Later in the discussion another delegate, a former dental nurse now working in palliative care, said that in the previous year she had not experienced anyone with oral cancer but “now, it’s only May and I’m on my ninth patient.”
Scroll forward six months and we have a report from the Oral Health Foundation (OHF) stating that oral cancer claimed the lives of more than 3,000 people in 2021 – a 46 per cent rise from the 2,075 recorded a decade previously. The OHF had used a Freedom of Information request to elicit data from, among others, the Office for National Statistics, Public Health Scotland, Public Health Wales and the Northern Ireland Cancer Registry.
In 2020-21, 9,860 people were diagnosed with the disease – a rise of 12 per cent over the previous year, according to the OHF. Early detection enjoys a 90 per cent survival rate but this drops to 50 per cent when diagnosis is made as the disease has advanced.
Professor Grant McIntyre, Dean of the Faculty of Dental Surgery at the Royal College of Surgeons of Edinburgh, says in this edition of Scottish Dental: “This is very worrying news. It highlights the profound impact when people struggle to access periodic NHS dental check-ups, potentially leading to delayed diagnoses of head and neck cancer. Lack of access to routine dental check-ups is a significant barrier to identifying a range of diseases and we would therefore call on government to urgently ensure funding is in place to make NHS dentistry accessible to all.”
The OHF’s report noted that around 88 per cent of UK adults were aware of mouth cancer as a condition but that awareness of the signs, symptoms and risk factors was as low as 17 per cent. “Improving access to NHS dentistry, tackling late diagnosis, and protecting public health policies are some of the key challenges in confronting mouth cancer,” said the report’s authors.
With the interval period for a routine dental check being extended from six months to a year – on the now widely accepted grounds that it is not necessary for most, healthy, people and that flexibility can be adopted for those considered more at risk – an unintentional hazard has been created; that of reducing the opportunity for the early detection of oral cancer. Again, it could be argued that the more-at-risk (of dental decay and oral cancer) patients may still be seen six-monthly. But there’s no guarantee.
Given the devastating toll wrought by oral cancer – and the increase revealed by the OHF – the question of a specific payment for oral cancer screening of NHS patients should be revisited, urgently.