Winners and Losers in the ICB Lottery
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- Published: Monday, 21 October 2024 08:06
- Written by Peter Ingle
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Major inconsistencies in commissioning across the 42 ICB‘s in England confirm that the NHS is anything but a national service when it comes to its approach to dentistry.
Having spoken with contractors in different areas, GDPUK has heard about the good, the bad, and the downright ugly, of different ICB approaches to managing NHS dental budgets.
Irrespective of ministerial pronouncements, the issue of whether or not a ring fence is applied to the dental budget remains a postcode lottery. Meanwhile, those ICBs that do seek to keep clawback money in dental care, are adopting a variety of different strategies.
The ICB’s covering the Midlands tend to act in concert and early signs from the West Midlands are not promising. Faced with a budget deficit they have made it clear that dental money will be re-routed elsewhere, to help balance the books. Relations between commissioners and GDP contractors are best described as cool.
In Greater Manchester it is a mixed picture. Above all, they should be credited with spending their entire dental budget. As reported in GDPUK last year’s initiative to put extra contract value on access sessions was generally reckoned to be a success, but it now removes eligibility for the new patient premium which can be worth as much as 4-10% of contract value. The ICB have also said that their financial circumstances leave them unable to fund delivery over 100%. This has left those practices willing and able to deliver extra NHS dentistry, unfunded.
In Mid and South Essex there have been a number of innovative schemes. Liaison with the LDC has been a regular feature of them. This November will see the start of their Children and Young People dental pilot scheme. This sets out to link practices to schools in a programme designed to set up preventive patterns for life. It sees practices at the centre of a push to provide dental support to schools for not only pupils, but also teachers and parents and carers. In keeping with the recovery plan’s ambitions it will make extensive use of the whole dental team.
In the North East and Yorkshire, ICBs have used available money in their dental budget to support access, including care for asylum seekers, supervised brushing programmes, urgent access sessions and higher minimum UDA rates.
West Yorkshire ICB speak of ‘investing time in building strong relationships with our dentists, practice owners and providers’. They too engage regularly with LDCs who have shared their approach nationally as good practice, and have been invited us to speak at the BDA conference.
In practical terms this has meant that in 2023/24 they set out to use the full dental budget. They invested approximately an additional £8m through a £6.5m investment plan. A further £1.5m enabled practices that were delivering their full contract to go 10% further, so providing additional access to patients. The £6.5m included a range of initiatives, including urgent dental sessions, orthodontics, access for children living in the highest need areas, access for homeless groups, access for refugees and asylum seekers, access for domiciliary patients, and an innovative level 2 paediatric service.
One problem with the 2006 contract that has not only remained, but got worse, was the wide variation in UDA rates. Nearly two decades of reduced funding and rising costs, coupled with inflation, have made the disparities even more stark. Here too, imaginative ICBs have been able to ease the pressures. Apart from minimum UDA rates, those access projects that offer a fixed sessional rate for a certain number of patients, by pass the UDA rate differentials.
These local schemes, some of which predate the national recovery plan and Labours election promises, still matter. The manifesto pledge of 700,000 appointments nationwide sounds impressive, but is the equivalent of just six patients per practice, each month.
To quote West Yorkshire ICB: “We’ve established a pragmatic way of working with our practices, based on forming a shared understanding and finding agreeable conditions to ensure service continuity.” The reality is that ‘service continuity’ may simply not be as important to some ICB’s as it is to others.
In Greater Manchester Dental Provider Leadership has worked very closely with the ICB to put a base under NHS Dental Service and and make clear it has a future and central to healthcare in the area. Our Quality Access Scheme is a 6% additional payment for each contract engaged delivering a threshold of new patients access. In Greater Manchester The access scheme sees all participating practices and their reception teams connected helping patients navigate and has offered in its 1st year 100,000 new patients and similar urgent care. In addition we offer an Urgent care referral system with a network of practice over the patch, Chlid friendly practices in each Local Authority. Practices in Greater Manchester can opt into the national new patient access scheme. Our challenge is to make these recurrent.
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