Information aboutthe number and percentage of dentists who undertake some private work is not held.

Community Health Partnershipsare part of NHS boards, and therefore receive delegated budgets from boards to delivera range of services. Those include all primary and community based services, includingservices for those living with long-term conditions such as arthritis.

This is primarilya matter for NHS boards. To encourage them to develop integrated pain services intheir area, we issued the McEwan Report in December 2004 under cover of HealthDepartment Letter (2004)48 (HDL), which described the report as providing ahelpful framework within which pain services can be enhanced. The HDL commendedthe report to boards, and asked them to give particular consideration to local issuesin respect of the services they provide for chronic pain.

We also expectboards to be familiar with the best practice statement on the management of chronicpain in adults issued by NHS Quality Improvement Scotland (QIS) in February 2006.

NHS QIS has been followingup both the McEwan Report and its best practice statement by means of a benchmarkingexercise intended to establish the current adult chronic pain services across primary,secondary and tertiary care. The report on that exercise should be published inthe near future and we will work with NHS QIS on the best way of taking forwardthe priority actions in that report.

The question refersto integrated services, and we would encourage boards to investigate the pain ManagedClinical Network approach being developed by NHS Greater Glasgow and Clyde.

The network will beresponsible for implementing best practice and quality standards in the provisionof chronic pain services, and developing patient pathways. As with all Managed ClinicalNetworks, the Scottish Government would be keen to spread the lessons learned, toenable the development of similar networks in other NHS board areas.

I refer the memberto the answer to question S3W-1343 on 16 July 2007. All answers to written parliamentary questions are availableon the Parliament’s website, the search facility for which can be found at http://www.scottish.parliament.uk/webapp/wa.search.

This issue will bediscussed with those who take forward the evaluation of the Toolkit.

NHS Quality ImprovementScotland is also carrying out an audit of care in rheumatoid arthritis to monitorimplementation of SIGN Guideline 48 and to investigate whether there are any significantvariations in the provision of care between care teams, hospitals and NHSboards.

The NHS board annualreviews will look at the services which each board provides for those with long-termconditions, as reflected in the completion of their CHPs’ long-term conditions self-assessmenttoolkit and action plans. We would expect chronic pain services to have been includedin that exercise.

The toolkit is meantto promote the improvement of services locally, according to the prioritised needsof each locality. The development of Managed Care Networks for the conditions mentionedwould be one of the possible vehicles for service redesign, and would be consistentwith the thinking in HDL(2007)21 on strengthening the role of Managed Clinical Networks.It highlights the role of Managed Care Networks in promoting integration of servicesacross the health and local authority sectors.

We shall thereforekeep this point in mind when considering the Action Plans derived from CHPs’ completionof the long-term conditions toolkit.

The Scottish MedicinesConsortium (SMC) provides the NHS in Scotland with adviceon new medicines. NHS Quality Improvement Scotland provides advice on technologiesassessed by the National Institute for Health and Clinical Excellence. The SMC andNICE consider cost-effectiveness information alongside the clinical and patientbenefits. Net cost per QALY gained is one factor in the decision making process.Guidance on incremental cost-effectiveness ratios and net cost per QALY gained iscontained in the NICE publication, Guide to the Methods of Technology Appraisalwhich can be found at http://www.nice.org.uk/download.aspx?o=201973.

We welcome the developmentof the pain Managed Clinical Network in NHS Greater Glasgow and Clyde, and are providing funding to help with its establishment.