General dental practitioners are largely paid to fix things. To examine, to diagnose, to treat and to review at whatever recall period is appropriate.
I remember thinking that when Margaret Thatcher said those words, written by speechwriter John O’Sullivan, that it was thoughtful of a politician to mention dentists. Thoughtful and unbelievable.
The use of the ‘Epistrophe’, the rhetorical tool of repeating of a word or phrase at the end of each sentence was used to echo Churchill’s ‘Anaphora’ of “We shall fight them etc”. Rhetoric has given way to the sound bite of, “The NHS is safe in our hands” which has always been Fake News or as my schoolteachers would have called it “Lies”.
The majority of politicians when given the opportunity have repeated the “safe hands” mantra. I wondered if it was a stock phrase they taught you at MP elocution school along with, “Hard working families” and "Education, education, education”.
“La-La Land” has been defined as “a euphoric dreamlike mental state detached from the harsher realities of life”. Few dentist fall into that category but I believe there are many who may hope: “To think that things that are completely impossible might happen, rather than understanding how things really are”.
A definition of madness is to do the same thing again and again hoping for a different result. Since Mrs Thatcher, governments of every hue have sought to undermine the dental profession by repeated assaults and insults both specific and general.
In the UK, like the majority of countries, most routine dentistry is provided by small businesses with the owners taking the financial risk of failure but also any profits from success. For years there was a 3-way set up, patient, dentist and NHS; the first paid the second the fees that were decided by the third that also set the rules. There was the possibility of competition, expansion and genuine entrepreneurship within the system. 2006 changed much of that.
The 2015 saw the Tories return to government free of their Lib-Dem coalition partners with talk of SMEs (Small and medium sized enterprises) being the “lifeblood of the economy”. Promises were made of more investment in super-fast broadband for entrepreneurs, a review of benefits for the self-employed and a trebling for the start-up loans programme.
A commitment was made by Prime Minister David Cameron (remember him?) to, “slash red tape” and to change employment laws to enable greater competition. One promise that was kept was for referendum, an excuse for any and all procrastination for the foreseeable future.
Cameron not only promised “the NHS is safe in our hands”, but also, “there will be no top down re-organisation” before letting Andrew Lansley set about things like a drunken bull manoeuvring a JCB in china shop.
The (genuine) news that the Inland Revenue’s “Make Tax Digital” (MTD) plans will mean all self employed individuals and small businesses having to make some form of tax return and payment on a quarterly basis hardly bodes well for dentists looking to reduce their costs. It will involve far more time and increase accountancy fees.
Changes in Business Rates will have a profound effect on many businesses, with London rates set to rise by 35.5% over the next two years. The fact is these changes should be made every 5 years but were delayed from 2015 so as not to interfere (i.e. prove unpopular) with the general election is further evidence of interference with the truth. Mrs May quickly promised help, then admitted there is no more money.
For years the GDC said that they could not make any changes and an act of parliament was required. This happened in late 2015, I am not sure that anyone has felt the benefits of “a more streamlined complaints system with timelier decisions, and with appropriate safeguards for both patients and dental professionals”.
Finally on the Fake News front that (new) NHS contract. As the BDA says, “The 2006 dental contract is not fit for purpose. It rewards dentists for hitting government targets for treatment and repair, not for improving their patients’ oral health.
In the 2010 general election, the opposition Conservative manifesto pledged a new dentistry contract. The coalition agreement – struck between the Conservatives and Liberal Democrats – pledged the contract would be introduced by the next election, in 2015.
In August 2016 Lord Prior said, “I believe that we expect the new contract to be introduced fully in 2018.”
And lawyer, John Grant ,wrote after yet another debate on the proposed contract.
“At some point there will be a new contract, but at present no one knows at all what this is going to look like.
When it does come in the government – no matter which party is in power – is going to want an awful lot more from dentists and in return is going to pay significantly less.”
If you think things can only get better (see 1997) then you are not only living in La-La Land but still expecting it to win the Best Film Oscar.
What’s in your GDS contract?
General dental services (GDS) contracts are lengthy, complicated and dentists are, on the whole, not fully accustomed to the plethora of legal terms that can be found in them – and why should they be? Dentists have undertaken substantial training to care for patients’ teeth and oral health, not digest convoluted legal phrasing and contractual terms.
Which is why it is vitally important for any dental practice owner who holds a GDS contract to have a comprehensive understanding of all of the terms to which they have agreed.
Thus, it is imperative to take proper legal instruction from a professional who understands the ins and outs of dental contracts – and who can offer relevant advice and ongoing support.
With this in mind, let’s discuss some of the more important points that require careful deliberation.
Firstly, clause 14 of the GDS contract concerns whether or not the Contractor has elected to be regarded as a health service body. This status determines the processes that will be followed in the event of any contractual dispute, and while this electing to do so will not affect any other aspects of the contract, there are benefits to not doing so.
For example, if a Contractor does not elect to be regarded as a health service body, they will be free to choose either the NHS dispute procedure or to proceed through the Courts should any contract disputes arise – giving a Contractor more options in the long term.
Another good example of where careful consideration must be taken is in clauses 198-200, which concern the permission of sub-contracting under the GDS contract. These may be useful if the contract is to remain in the name of the individual holder, but performed by a company – and may be considered an alternative to having the contract vested in the company on incorporation.
Notice of this must be served to NHS England in accordance to clause 199 – which states that any required information be supplied as quickly as reasonably practicable. Be aware that NHS England may seek a formal contract variation as a result.
Thirdly, clause 339 of the GDS contract states that where a partnership contract reverts to an individual contract, the NHS England has the power to terminate in the event that, in its reasonable opinion, the change is likely to have a serious adverse impact on the ability of the provider to perform its obligations. This could include the fact that there will be fewer performers (e.g. dentists carrying out the units of dental activity (UDAs) following a change from partnership to individual). This is a particularly pertinent consideration should one of your partners be approaching retirement, or if serious illness threatens the current partnership. Either way, a contingency should be arranged with your lawyer to ensure you are fully prepared for any eventuality.
There are many more points that need to be addressed before you commit your signature to the contract.
Goodman Grant Solicitors are experienced, dental-specific lawyers that fully understand the minutiae of GDS contracts. Their expert team is prepared to answer questions regarding any of the specific clauses of the contract and can provide a useful checklist to ensure that everything is in order before you sign.
Paul Harris of Goodman Grant Lawyers for Dentists – a NASDAL member
For more information call Paul Harris on 0151 707 0090 or email This email address is being protected from spambots. You need JavaScript enabled to view it.
www.goodmangrant.co.uk
A new director, Paul Harris joined Goodman Grant as a trainee solicitor in September 2010 and qualified to the Dental Team at the end of 2012. Paul works on a variety of dental matters relating predominantly to dental practice acquisitions and disposals – though he has an in depth understanding of all dental-legal issues that make him an indispensible member of the team
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.
ASPD MEMBER
Over 300 NHS dental professionals completed the second NHS Confidence Monitor, a comprehensive industry survey conducted on behalf of Practice Plan, sharing their views about the future of NHS dentistry. The aim of this on-going survey, which will take place every six months, is to gain insight into the profession’s confidence levels in NHS dentistry over the coming months and provide a snapshot of the mood of the profession going forward.
The NHS Confidence Monitor also revealed that dentists are very worried about their own future, with 90% of respondents saying they are less confident about their career prospects within NHS dentistry going forward than they were a year ago.
Confidence levels are also at a shocking low in terms of dentists’ ability to offer their patients the right balance of treatment versus prevention in times to come under the NHS, with 85% of respondents expressing fears that the balance won't be right.
94% of respondents said they had lost confidence that practising dentistry within the NHS will offer an appropriate level of remuneration in the future, serving as a worrying statistic for the Government since this is suggestive of staffing shortages in times ahead if dental professionals choose to leave NHS practice.
It also seems that there is little confidence that dental teams will be able to work effectively within the NHS framework as time progresses, with 89% feeling less confident on this matter than they did in the previous 12 months.
Perception of patient satisfaction is also at a worrying low, with over three-quarters (77%) of respondents lacking confidence that patients will be happy with the outcome of attending an NHS dental practice in the future, when compared to 12 months ago.
Commenting on the results, Eddie Crouch, Vice Chair of the Birmingham Local Dental Committee, stated: ‘I think it’s worrying that so many people have become markedly more despondent since the last survey. I think it’s partly anticipatory and partly because the issue appears to be so low down the Government’s list.
‘It seems a sad state of affairs and we can only hope that results such as these will persuade the powers that be to look at the situation anew in consultation with representatives of the profession.’
Each NHS Confidence Monitor survey will be followed up with a forum of key opinion leaders, dentists and dental professionals to explore the results in greater depth and place them in context. The next forum is scheduled for October 2015, after which the group’s opinions on the survey results will be made available to the dental profession in the UK.
In the meantime, to see the full results or for further information on the NHS Confidence Monitor, please visit www.NHSDentistryInsights.co.uk.
