The Writing on the Wall? NHSE Evidence for Pay Review
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- Published: Tuesday, 17 December 2024 10:45
- Written by Peter Ingle
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The profession‘s negotiators have been very clear. NHS dentistry has been sitting at the bar of the last chance saloon for a while.
While practices are still waiting to receive the April 2024 uplift and see how much has been hollowed out by the expenses calculations, the Doctors and Dentists Review Body (DDRB) has called for evidence to help it set the 2025/26 award. That evidence comes from a variety of sources including NHSEngland (NHSE). Will NHS dentists be encouraged to hang on when they read the NHSE document?
The general summary in their submission does not mention dentistry specifically but the messaging is clear. ‘The NHS remains under enormous pressure’, it begins. The scene is then set of a service still recovering from the pandemic, but making ‘solid progress.’
Workforce, both numbers and morale, as well as recruitment challenges, are mentioned. In June 2024 the most common reason for sickness absence among doctors were mental health conditions including anxiety, stress and depression. GDPUK readers will not be surprised to read that the morale of general medical practitioners is lower than that of other doctors.
The tone soon changes: ‘Going into next year, NHS funding will be extremely tight, and it will constitute a year of significant consolidation.’ With the NHS revenue settlement likely to grow by 2% in real terms, ‘the NHS will not be able to make material investments in new services and meet all its pressures from the uplift available, including the usual growth in capacity that is necessary to meet demand growth.’
The NHSE view on affordability is based on discussions to date with the Department of Health and Social Care (DHSC) and what was set out by HM Treasury in the Autumn Budget 2024. Based on this, they propose to set allocations for NHS planning on the basis of a 2.8% pay settlement.
The summary concludes ominously: ‘We have already made significant prioritisation decisions. Pay awards above what has already been allocated will require further tough re-prioritisation of the decisions already made, significantly impacting patient care and in turn making the day-to-day job of NHS staff even harder.’
Problems are acknowledged with a once reliable part of the supply chain of NHS dentists. A loss of FD training sites is described as a growing risk impacting the placement of UK graduates. ‘The decline is driven by factors including the workload on training practices and educational supervisors, as well as static payments for the service component of training, which have not increased since 2013 despite rising inflationary costs. The payment issue is a disincentive for practices and requires urgent review from relevant government bodies.’
There is mention of the Dental Education Reform Programme (DERP) which includes work to develop more flexible training, and support more multidisciplinary working. That dentists will be released for more complex work as all members of the dental team work to their full scope of practice, appears to be something that NHSE have priced into their calculations.
When it comes to GDPs there is recognition of the access challenges and a reminder that a high proportion of dentists delivering NHS dentistry work as self-employed associates. Evidence is then presented to support NHSE’s view of NHS dental services and the recruitment, retention and morale of both NHS dental contract holders and associates.
For delivery of NHS dental contracts the conclusion is that the number of UDAs being delivered as a proportion of those commissioned has continued to improve since the end of the pandemic.
As regards the number of dentists providing NHS care, it has not fallen, though it is conceded that some dentists have reduced the time spent on NHS work. Despite this, the conclusion is that it remains within the range seen over the last decade.
NHSE take the view that the number of dentists providing NHS care has begun to stabilise, and contract delivery has continued to improve.
There is recognition that there has been a drop in the proportion of contract holders and associates reporting ‘very high’ or ‘high’ morale, and that it represents a continuation of a downward trend. However levels remain comparable with dentists in other countries of the UK, and this is taken as support for the view that the contract in England is not the dominant issue.
There is a section that will particularly resonate with GDPUK readers: “The single largest reported driver of low morale in provider-performers was expenses versus income.” In addition provider-performer dentists’ concerns about recruitment and retention were negatively affecting morale. Associate dentists were more likely to identify concerns about litigation risks and indemnity fees as causes of their low morale. Another moment of clarity follows: “This data suggests there is anxiety within the profession that the complexity and therefore cost of providing dental care to some patients is higher than the financial return.”
In mitigation the increased minimum UDA rate and New Patient Premium are described. Any hard pressed readers may want to check they are sitting down safely before reading that, “NHS dentistry remains profitable for both contractors and associates.”
Recruitment is considered, and the vacancy rate for NHS general dentists in England given as 17%. Again, recent changes are used to suggest that the situation is already set to improve, in this case with the ‘golden hello’ scheme.
Registrants completing their GDC renewals may be interested to see that while NHS data, and that from NHSBSA and NASDAL have been used to develop the document, the GDCs much vaunted data collection exercise has not.
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