As we all know, a new NHS contract has been mooted for the last three or four years. The major problem that the Government currently appears to be struggling with is that, for all its flaws, the current system very precisely provides control over the spend.

So the Government is trying to implement a new contract whilst retaining this same level of control. However, it is very difficult to envisage a system that will allow them to do that and satisfy the dental profession.

For the last few years, everything seems to have been focused on reducing spending on NHS dentistry. This can be seen with both GDS and PDS contracts. As the PDS contracts come up for renewal the LATs are taking a much harder stance and reducing values wherever they can. 

There was a time, a number of years ago, when over 50% of practices had not achieved their UDA target on a regular basis and yet no action had been taken by PCTs to recoup any monies. This was certainly the case for the first five years of the current contract; however, one of the changes we have seen recently is a significantly stronger focus on performance. So that now if a practice does not hit targets, not only will the LAT recoup the money but they will seize every opportunity to reduce the contract value, either by decreasing the number of UDAs or lessening the UDA value. 

Under any new contract, if there is one, underperformance and failure to achieve KPIs is going to lead to a similar situation. Whilst the latest prototype proposed contains remuneration based on capitation, the number of patients that you have registered, the work performed and some for achieving KPIs, the potential risk for missing these targets is a massive 10%. Nevertheless, a lot of the essential details here remain unknown.

In some ways the most concerning part about the change in contract is the notion it might be time limited. This completely fails to recognise the investment that dentists have to put into practices, not only in terms of equipment, but also regarding the time spent building a good dental business. To fit out a dental practice is a very significant cost, and nobody is going to do that if there is a contract that only lasts for five years – over that period one is not going to get back that which one has paid out, never mind actually make any money!

It seems, whether stated or unstated, that it is the Government’s clear intention to reduce spending on NHS dentistry. To achieve this, perhaps all they would have to do is introduce time limited contracts and there would be a very large shift away from NHS ownership towards private.

And this, in my opinion, is what the Government wants. They need to save money and whilst they talk about the NHS in hallowed terms, I’m not so sure that NHS dentistry is quite so hallowed as the rest of it.

John Grant of Goodman Grant Lawyers for Dentists

For more information call John Grant on 0113 834 3705 or email This email address is being protected from spambots. You need JavaScript enabled to view it.

www.goodmangrant.co.uk
 

ASPD MEMBER

Following similar campaigns for medicine and pharmacy, (no I hadn't noticed either), last week NHS England launched the dental call. It was trumpeted with documents with the admirable aim of improving dental care and oral health, but the large caveat is this must be done with a reducing budget and a £30 billion black hole in the NHS funding stream. One wonders if loosing dentistry from the NHS might infill some of the cavity.

We are told that the NHS dental budget is £3.4 billion per year and that private dentistry makes up £2.3 billion in provision, although some may dispute that. £653 million from patient charges is included in the total budget and is an important part of the contribution. In view of what the government is prepared to pay on other issues, one wonders why it is needed at all, but of course patient charges are a controlling factor of the demand.

Much is made of the Dental Local Professional Networks that have recently been established, but no mention of the chronic underfunding of this, which might explain why so few of us will have noticed their existence to date.

The NHS belongs to the people is the strap line, but not sure the way politicians interfere with it, make any of us feel like the owners.

The document attempts to describe many strengths in the current system and improve access. At a recent GDPC meeting I asked Elizabeth Lynam , head of dentistry at the DoH would there be funding for more patients to register if a reformed registration and capitation model attracted more than the 56% currently visiting practices in a 24 month period, no was the answer.

So if access is to increase, that too must happen within the existing budget. Not so much a call to action as a call for charity from the profession.

As a committed LDC official, I am disappointed that there is not a single reference to local representative committees, nor a mention of them being stakeholders. Perhaps with the manipulation of levy collection ongoing by NHS England maybe they won't be for long anyway?

We are asked to respond to the questions by the 16th May 2014 and that our answers will be independently analysed, we are not told by who,( I am lead to believe it may be an American institution, so much for tendering) but it will make a change for independent analysis when we are deprived that within the pilot programme. A strategic framework for commissioning will be published along with a report.

There is pride on the excellent data on disease and activity NHS England hold but those that witnessed the destruction of the Dental Practice Board will believe this information far inferior to what was previously known.

Again there is a plan to best use tax payer’s money and develop a workforce that is appropriate for the future, a bit rich after what graduates are facing in the lottery of FD placement. But world class has been replaced by exemplar commissioner so perhaps reality is dawning at Whitehall. I wonder where the "tools" to enable a consistent care pathway are being kept.

Remarkably the document admits they need to know how to measure excellence and despite telling us how good the data is they have, they admit they lack data to benchmark performance nationally. I know what I believe of these two versions on data.

In its section on health inequalities it talks about a "seldom heard" group, I got quite excited when I thought it might be the many critics of DoH and NHS England but it turns out to be patients facing barriers to accessing care.

There is a clear message they we carry out our care at times convenient to us, and that patients want extended hours after work and at weekends. Not sure what evidence base there is for this, but the direction of travel is clear.

Much is made of the OFT report of 2012 despite massive criticism from the profession and the BDA. So not much notice taken there then, and of course they trumpet this call to action process is being supported by the BDA. Damned if you do and the same if you don't .

There are also indicators to the shape of general practice of the future, they want to move away from working in isolation and support larger teams in the interest of better care, and develop special interest in primary care. The end of single handed practice and tiered delivery of care for those with the badge to do it is just a review away perhaps?

It is followed by a list of questions deliberately moulded to either restrict answers or get the ones they want, but none the less I would encourage all to let them have the "action" by going to

www.england.nhs.uk/ourwork/qual-clin-lead/calltoaction/dental-call-to-action/

Whilst I understand enthusiasm for this is not great and we are being herded along with the medics, we should not under estimate the importance or messages contained.

Eddie Crouch

What can CHALLENGE do?

• CHALLENGE will argue and lobby powerfully in support of the dental profession’s position as the key providers of oral health care in the UK. The process of building a new dental service cannot be done in secret.
• CHALLENGE will organise forums and events in which key players can be given the chance to air their views and break through the logjam created by the BDA and the Department of Health both of whom have excellent reasons to exclude others from the debate.
• Carry out field research among the profession to establish their opinions, hopes and fears. This is not a feature of any of the work being carried out at the moment. Suppressing the voice of the dental profession is unforgiveable when it is the profession as a whole that will be required to carry out whatever emerges from the discussions, using their businesses and the human resource they control. That voice must be heard loud and clear.
• CHALLENGE will listen to the voices of those whose work is strongly linked to the dental profession and industry but not part of the established professional hierarchy. The dental industry supports the dental profession in a symbiotic relationship – each needs the other. The importance of that element of the industry needs to be recognised.

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Key principles underpinning the CHALLENGE approach to a new GDS contract in 2014/5

Any new system must concentrate its efforts on delivering –

·         Improved oral health for the population as a whole

·         An oral care system that patients understand and can trust

·         A profession that can take pride in its work

These are the simple but important features of a successful contractual arrangement between the dental profession and the Government.

In addition, CHALLENGE would say that the following issues are just as important -

·         A system where the roles of the state and of individual service providers  are crystal clear

·         A system in which the NHS and non-NHS system work in combination, not in opposition

·         a system in which the profession is encouraged and empowered to act professionally

Whatever emerges from the discussions between the profession and the NHS must be able to demonstrate that it has matched these issues with due sensitivity to the needs of both sides. Both sides need to recognise the need for fiscal control and integrity and both sides need to understand that if high clinical standards are required then the funding has to be there to support those standards.

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It may all end in tiers

In his independent review NHS dental services in England, Jimmy Steele placed advanced care at the top of the pyramid he created for prioritisation, and care pathways determined how patients might scale this structure to reach the pinnacle.