Crunch Time Approaches
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- Published: Monday, 31 January 2022 07:03
- Written by Peter Ingle
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For many years there have been regular predictions of the impending demise of NHS dentistry.
Despite new contracts, clawbacks, medical inflation and the best efforts of NHS commissioners and local teams, dental practices have kept on providing NHS care. Ministers could claim that based upon their chosen measure, whether it was registrants, courses of treatment or numbers of contracts, that all was well. The front pages of the early 2000’s reporting a lack of access to NHS dentistry had long ago stopped being big news. The rise of the corporates and a supply of willing EU workers kept even the 2006 contract on the road, delivering the numbers needed to save the Government’s blushes.
Many thought that Brexit would see huge numbers of dental team members from EU nations leave the UK. But there was no mass dental exodus after January 2020. Then came the once in a century curve ball of the pandemic, threatening to put practices out of business. In the event, at first, it was a comparatively good time to have an NHS contract. Most NHS income was protected, a stark contrast to the lack of support for private dental practices.
As the economy reopened and restrictions eased, pent up consumer demand became apparent. Despite the limitations of both the furlough scheme and support for the self-employed, it was clear that patients had sivngs and were ready to spend. Nor were there enough dentists in the surgeries. Some patients unable to see their NHS dentist, discovered private practice, and the good service it could offer, for the first time. Meanwhile those with a major commitment to the NHS began to feel the heat. The disruptions of repeated restrictions and patient concerns were dwarfed by the effect of SOP’s that slashed productivity with the imposition of fallow times. Even at the initial 20% UDA target there were winners and losers. If you had a building that was difficult to ventilate, or if you carried out a higher than average proportion of AGP’s, life was challenging. As the UDA target was ratcheted up on a quarterly basis, more practices began to feel the squeeze. Last minute announcements of targets and a submarine CDO, further eroded goodwill. The announcement of the 85% target from January 1st 2022 was appallingly timed, just as Omicron began to threaten to bring the country to its knees, leaving practices short, with both team members and patients testing positive and isolating.
In the background, while registrant numbers just about held up, there was an increasing flow of dental teams to private work with NHS figures showing a loss of 1000 dentists in a year. In some areas longstanding shortages put more pressure on remaining NHS practices. The BDA confirmed NHS dentists’ suspicions that they were slipping down the earnings table, with evidence of an up to 40% drop to their income in real terms over the last decade. The shortage of associates meant that they could be choosier about how and where they worked, with many NHS vacancies proving hard to fill.
Just as dental practices were digesting the latest CDO exhortation to do more with less, and pressurising them into taking on extra emergency patients, compulsory vaccination against Covid was announced. With a February deadline approaching, came the threat of a possible instant 5% loss in the workforce. Meanwhile the clock is ticking down to March 31st 2022 and NHS contract holders struggle to hit the new 85% UDA target or face clawbacks, and possible breach notices.
There was little comfort for dentists hanging on to see the promised, but long overdue replacement for the UDA system. It was announced that the trials of prototypes for a new dental contract, testing two new payment systems, would end in April. Neither would be adopted and the 102 practices involved faced major disruption and an uncertain future. In the words of the BDA, they were “thrown under the bus”.
In many constituencies, MPs once again found that they were getting frequent complaints about the lack of NHS dental services. The Government funded organisation, Healthwatch began to take an interest. An enterprising member of the Communist party standing for election to East Suffolk Council, found that the local electorate were possibly more interested in teeth than Trotsky, and Toothless in Suffolk was born. Soon the local press and BBC were covering this campaign. News stories of desperate patients struggling in pain or resorting to DIY dentistry have made a comeback.
By mid January in Parliament, it was notable that it was a pair of Conservative MPs complaining of the problems that their constituents faced, and asking the minister when the UDA contract would be replaced. The next day the BDA unleashed a media onslaught with many dentists interviewed, all emphasising that NHS dentistry was on the brink. In what many in the profession concluded was a hasty attempt to turn the news agenda, the one off 50 million pound “blitz” of extra appointments was announced soon after. It comes with strings, as it is expected that the extra appointments will be offered at weekends and evenings, to priority groups, and must be completed by March 31st. The funding is to include hospital and CDS provision as well as general practice. How appealing this will be to short staffed practices already straining to meet UDA targets for March 31st remains to be seen, as does just how much hospital or CDS dental treatment even 50 million pounds actually buys. The general response from GDP’s has been at best, lukewarm. As more practices leave the NHS those remaining will be under even greater pressure from both patients and commissioners, and the situation is likely to deteriorate.
The dental plan providers report busy recruitment teams as practices gear up for a big change in these short weeks leading to April 2022, and once this major decision has been made, there is no going back. Clearly the multiple failings of politicans in power over decades have proven to practice owners the future is better without the NHS GDS contract.
This does not look like a crisis that will go away anytime soon. There will be a parliamentary debate on February 10th about NHS dentistry, which has been sponsored by a Conservative and Labour MP. The Government may soon have to decide between the political horrors of overseeing the final collapse of NHS dentistry, take the huge political hit of switching to a core service, or massively increasing the treasury’s contribution to the service. It is almost enough to make hard pressed NHS dentists feel sorry for them.
Crunch time approaches
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