The Historical and Political Background to the Proposals for Local Commissioning of Primary Dental Care by Primary Care Trusts

Abstract

This paper provides a background to the changes that are about to occur in the system for primary oral healthcare delivery in the NHS. This is part of a far wider reform programme involving all public sector services. The challenges that the Government faces are not unique: all countries are striving to alter their care systems to address the changing expectations of the electorate while attempting to control both the costs and inequalities. What is unique to the United Kingdom is the historical legacy of the NHS and its political importance, which should not be underestimated. An overview of the agenda for change in all parts of the health sector is presented. This is followed by a more detailed analysis of the proposals for future delivery of primary oral care in the NHS and the subsequent issues arising. A consistent theme running throughout the Government's agenda is devolution. Indeed, the detailed programme discussed in this paper applies only to England and Wales. The fact that Scotland has different plans highlights the importance of the political and cultural setting to any reform programme.