Oral and maxillofacial surgery in the United Kingdom and Germany

The provision of healthcare is a complex choreography involving key stakeholders who plan, coordinate, fund, and deliver education and care. No element is independent of any other. Pressures or changes in education, economics, society, and healthcare professions can cause positive feedback loops that lead to unanticipated consequence that may be negative for patients. Maintaining channels of communication and respecting the perspectives of those with a different viewpoint and knowledge base lead to the best, or perhaps least worst, outcomes. Specialist training and continuing medical education are usually designed and provided by professionals. Funding may come from the government, patients, or insurance sectors. This paper will focus on some examples from Germany and the United Kingdom and consider whether there are lessons to be learned. The funding and provision of healthcare are complex even when the majority of care appears to have a single monopoly provider as is the case in the United Kingdom. It is important that those who are undertaking changes to working systems are aware of the risks of unintended consequences. In the United Kingdom, the National Health Service (NHS) has undergone regular top-down reorganizations of the provision of care. Some of these may serve as lessons for other nations. When some care is provided by independent providers working in their own offices, changing the organization and funding systems may result in changes in provision and costs that are unanticipated and impactful. This paper considers how an element of Oral and Maxillofacial Surgery (OMFS) care (the outpatient removal of teeth) has been impacted by funding changes and highlights an example in Northern Ireland where service provision was maintained through serendipity.