Beginning Of The End For UDAs?
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- Published: Monday, 07 March 2022 09:23
- Written by Peter Ingle
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The consensus that the UDA system should go has grown since its conception and now even MPs and the ministers in control seem to agree.
Desperately looking for a villain our elected representatives cite the expanding access crisis, blaming the UDA as dental public health enemy number 1.
With a stream of practices handing back their NHS contracts, and even Conservative MP’s demanding it’s removal for April 1st, the pressure is on to terminate the UDA. In the search to replace UDAs there were alternative systems trialed - the prototypes. The treasury’s unwillingness to pay the going price for health care has now killed those prototypes, they will now not be adopted.
England and Wales have both had UDAs, and a letter to Welsh Dentists may show the shape of things to come for their English colleagues. The letter comes from Alex Slade, director of Primary Care and Mental Health, and Warren Tooley, the Deputy Chief Dental Officer. Pre pandemic, 40% of Welsh NHS practices were involved in or signed up for contract reform, but this was paused. Since then, the post pandemic ‘recovery and reset’ phase has allowed testing of alternative measures. From April 2022 the programme will restart using an “action learning approach.” Practices will have a choice to either be part of the reform process, or return to UDA’s where the new target will be 95% of the pre Covid level. The letter states that the short notice for the publication of details of the reform option is due to Covid. 2022 -2023 will see a “test and modify” approach adopted. It adds that reform “has to be fair for dental teams, health boards and patients.” There is reference to the importance of access and that NHS dental care should be available to anyone who wants it.
Orthodontic contacts will revert to 100% UOA targets from April. In general practice, UDA’s will need to be involved until GDS regulations are amended, however those choosing the reform option will have a substantially reduced UDA target. It is emphasised that this is not a new contract but the restart of the reform programme that it is hoped will lead to one. A worked example of the variation is provided. It assumes a 6800 UDA target at £25 each, totalling £170 000. Under the variation, 25% of the contract value is allocated to existing metrics, the remaining 75% being allocated to new metrics. These are broken down into items such as Fluoride varnish at 5%, a new patient target of 25%, and 40% to supply mandatory services to existing patients. To get these parts of the contract payment, targets will need to be met. For example the 5% fluoride varnish contract value requires 80% of all red or amber caries risk subjects to receive it. The new patient target would need 260 new patients to be taken on and treated, this being kept proportional to the total contract value. The new patients will need to have both an examination and course of treatment to count towards the target. “Existing patients,” a group many thought outside the UDA contract, are involved too. The example practice would be expected to see 1280 of these, again in proportion to contact value. There is also a Recall Interval component which accounts for 5% of the contact value. There are other requirements in relation to urgent treatment and completion of ACORN, the Assessment of Clinical Oral Risks and Need.
There is a lengthy Q and A section. Amongst them, there is one about patient charges where it is expected that the total level of PCR will continue to be below pre pandemic levels. Another question tries to provide an answer to working out associate payments.
In all, some critically important reading for Welsh practices, and all less than a month before the start date. Dentists in England will be watching closely, perhaps wondering how much notice they will get when their time comes.
In a blog on the BDA site dated 2nd March, GDPC Chair Shawn Charlwood writes: "Nothing is agreed, until everything is agreed. So, to give the process the best chance of succeeding, we need to have the opportunity to discuss things candidly on a confidential basis with our opposite numbers at NHS England. What I can tell you is that the discussions have been divided into two distinct sections: quick wins and long-term reform. Much of the immediate focus has been on achieving quick wins with the stated intention of announcing those by April 2022, which is of course now not that far away."
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