Denplan has released its latest research (commissioned through Facts International), based on a survey asking NHS dentists* for their views on a variety of issues related to NHS dentistry.  The survey examined their opinions about the current contract as well as their knowledge of the pilots and prototypes.  Other key issues the NHS dentists were asked about included their confidence around NHS funding commitments filtering through to primary care dentistry, motivation levels for making changes to their practice situation and the impact of the Friends and Family Test. 

The key findings are summarised below:

Current NHS contract and prototypes

• Nearly half the dentists (49%) are dissatisfied with working under the current NHS contract, with only 3% very satisfied and 29% saying they are fairly satisfied
• Two thirds (65%) of dentists don’t feel very knowledgeable about the current situation regarding NHS dentistry pilots and prototypes, rating their knowledge as fair or poor
• Three quarters (76%) agree that they are frustrated that more than four years after piloting began we are still no nearer to a final model
• 57% of these frustrated dentists have decided on making changes to their practice in the next 12 months
• Only 54% are aware that the pilots will soon terminate and that a number of practices will act as prototypes for the reformed NHS contracts in England.  66% of these think that it is unlikely the prototype model will free them from the UDA system

NHS funding for primary care dentistry

• 95% of dentists are not confident that political assurances for NHS funding commitments will filter down to primary care dentistry
• 56% think that the 2006 contract’s cap on the dental budget will not be reversed
• 86% of dentists overwhelmingly agree they would like NHS England to state clearly what is and what is not available in NHS dentistry – just 2% disagreed

Impact of Friends and Family Test

• 72% have commenced using the Friends and Family Test (FFT) that was introduced in April but the majority of respondents (73%)  didn’t think the FFT would be useful for either their practice or their patients

Roger Matthews, Chief Dental Officer at Denplan commented: “It is apparent from these survey results that many NHS dentists continue to feel disillusioned and frustrated with the lack of clear direction around the NHS contract changes. There also appears to be a general lack of understanding in relation to the pilots and prototype models.  With the realisation that the NHS funding situation for primary care dentistry does not look likely to improve, it is unsurprising that many NHS dentists may be feeling uncertain as to the future viability of their practice if they stay with the NHS. The result is that a significant proportion of NHS dentists are considering a change to the way they manage and fund their practice in the foreseeable future.

“Dentists appear to also be concerned about the hours it will take their practice to compile the statistics from the now mandatory Friends and Family Test, with half saying it will take their practice between 1-4 hours a month to process the results. This could add up to the equivalent of at least 6 days a year spent away from delivering patient care.”

Matthews added: “Managing the transition from NHS to private dentistry can be a daunting prospect for many dentists, but at Denplan we have a long heritage in supporting NHS dentists in making this transition, helping to ensure they retain their practice income and continue to run a successful practice in the future.   Denplan ‘Principal only Transitions’ give dentists the option to retain NHS patients whilst benefitting from all the support and experience necessary to choose the right payment plan for them, their practice and their patients.”

Denplan is running a series of seminars throughout June, entitled “Your practice, Your Choices” which will examine the upcoming changes to  NHS contracts for dentists, how dentists might be affected and help them understand what actions they need to be considering now.  For further information and to book a place practices can visit: www.denplan.co.uk/events-and-training/your-practice-your-choices or call 0800 169 5697.

*100 dentists responded to an online survey in April and May 2015, with all respondents holding an NHS contract in England, treating over 70% of their patient base as NHS patients.  They were not part of a corporate body or a member of a payment plan provider.

Friends and Family Test [FFT]

The FFT will be introduced to dentistry in England on 1^st April 2015, which some might consider an appropriate date to introduce such a tool. David Cameron is an enthusiastic supporter and believes this simple test will provide “a single measure that looks at the quality of care across the country."

Others, including the Picker Institute, the Kings Fund and the British Medical Association are somewhat less impressed with the value of implementing such a tool. Chris Graham of the Picker Institute has stated that “the ‘simple, headline metric’ used for the test does not provide a reliable basis for comparing services or identifying those performing best.” Dr Kailash Chand, deputy Chair of the BMA, is slightly more direct in his criticism. He has described the FFT as a “political gimmick” and asserts that the last thing we need is to collect “more meaningless or misleading data”, a comment which I’m sure will resonant with many dentists.

Sadly this point is obviously lost on the Prime Minister, who continues to believe that the FFT will allow everyone to “have a really clear idea of where to get the best care”. It is hard to believe that such a simplistic tool could actually improve the quality of patient care in dentistry. (I refer to the FFT, and not the Prime Minister!) 

The only value would appear to be in the free text question, which we have naively been given freedom to design ourselves.

The simplest approach would be to ask …. “Why?”

As in, “why did you answer the previous question in the way which you did?” Rather than “WHY?” in the context of a dentist screaming at the moon, as another pile of ill-conceived bureaucracy is dumped on them from a great height courtesy of some narcissistic NHS manager.

Other suggestions for free text questions have included:

“How much of a waste of time do you think this is?”

“What three words best describe the people who developed this questionnaire?”

In the spirit of Patient and Public Involvement, it might also be worth considering the following as a suitable second question…..

“What question do you think we should include as our second question?!!!!”

It is tempting to treat the FFT with the respect which it deserves. NHS England appears to be resigned to this approach, judging by the fact that there is currently no target set for the number of responses required! The introduction of FFT is a contractual obligation and I can’t imagine that this laissez-faire attitude will persist. Perhaps they will include it within a future iteration of the DQOF as another measure of how well we complete our paperwork. The term “biro dentistry” is about to take on a whole new meaning!

So what should you do?

In our practice, we are fortunate to have a highly motivated, efficient practice manager, who seems to revel in the imposition of NHS bureaucracy. She obviously looks at the FFT as yet another challenge to be overcome, and failure to do so would be seen as a sign of weakness. She has organised strategy meetings, staff training, team discussions and already delegated duties. None of which involve me filling in a pile of FFT forms…… as yet!

There is unanimous agreement within our practice that the FFT question is a complete waste of time. It is not a reliable indicator of quality and provides inadequate information compared to our existing patient questionnaires. We see this as an additional burden on our staff, our patients and our practice, but will reluctantly comply and attempt to use the free text question properly to gather some feedback.

So what should the profession do?

As a profession, we need the BDA to take a strong stance and challenge NHS England on the introduction of additional bureaucracy, which quite clearly has limited patient benefit. It is correct that the BDA support the introduction of measures of quality, but such tools need to be valid, appropriate and worth the paper they are written on. 

Patient experience data is of considerable value in terms of improving the quality of patient care and there is obviously an increasing amount of data that is going to be collected, analysed and interpreted. This takes time and resources, but can only be justified if the data collected is robust, reliable and can ultimately be translated into improvements in patient care. If the data is not robust and reliable, the exercise will be a waste of time and simply add to the level of unnecessary bureaucracy and administration, which we have to deal with. It is not acceptable to measure what is easy to measure, rather than what is actually meaningful. This is ineffectual, burdensome and demoralising for staff.  

Jocelyn Cornwell of the Kings Fund states that “patient experience measures will only work if clinicians as well as managers take them seriously, and in general they don’t. Clinicians will reject measures they see as inappropriate or unreliable, and will not act on the results.”

We have an opportunity to put quality at the heart of the dental contract reforms, and Patient Reported Experience Measures are going to play an important role in the evaluation of quality. The current approach of NHS England does not instill confidence and it is therefore vital that the BDA, the FGDP and others influence how quality is measured within general dental practice.

1.    Department of Health. NHS dental services in England - An independent review led by Professor Jimmy Steele. In: Health Do, editor. London: The Stationery Office; 2009.

2.    Professor the Lord Darzi of Denham K. High Quality Care For All. NHS Next Stage Review Final Report. London2008.

3.    Kings College London and The Kings Fund. What matters to patients'? Coventry2011.

4.    Department of Health. Dental contract reform: Prototypes, Overview document. In: Legislation and Policy Unit DaES, editor. London: HMSO; 2015.

 Image credit - Glyn Lowe  under CC licence