NHS England and DHSC Announce End of 2006 UDAs
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- Published: Tuesday, 01 April 2025 08:02
- Written by Peter Ingle
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It appears that the soon to be axed NHS England will be going out with a bang. The arms-length body is to be merged with the Department of Health and Social Care, but it will be taking the despised 2006 UDA with it, into healthcare history.
Units of Dental Activity were the foundation of a contract that is now recognised to have acted against the interests of patients, as well as the profession. Their unsuitability has been accepted for many years, but the challenge has been finding an alternative acceptable to both Government and dental professionals.
Making the announcement representatives of both NHS England, and the Chief Dental Officer’s team, explained the radical thinking behind the new system. It is the distillation of many years of careful research, engagement and consultation between all the key stakeholders. To ensure proper representation discussions were held with representatives of mental health organisations, dental claims companies, the GDC, CQC and treasury officials.
Indeed, it is the former group that we have to thank for idea behind the new system. Speaking at the launch, Lee Cluss of the Office of the Chief Dental Officer (OCDO) drew on his experiences in practice: “I can still recall the stresses and anxiety involved in day to day dentistry. The complete denture patients returning again and again, and telling me that they could not chew their well-done steaks. The mums telling me that their rampant decay afflicted children never had sugar, just after feeding them iced doughnuts in the waiting room. Not forgetting the hottest pulps on the most nervous patients, and so much more.”
Expanding upon the stresses of practice, he explained that this inevitably had a deleterious effect on the well-being and mental health of dental team members. It was the reason that back in 2007 he had left general practice after six months, to start his Dental Public Health studies.
At this point, Debi Maud Sub Director for Dental Improvement of NHS England took over. They explained that whilst potentially cost neutral the option of retraining the entire workforce to become consultants in dental public health might leave some gaps in service provision. More importantly, it would deny the Treasury and Office for National Statistics of any data to allow them to announce that targets had been both set, and achieved.
This had led to the adoption of a compromise where it would be the stress and difficulties that would form the new metrics. “We cannot eliminate those stresses, if we are to meet our manifesto commitments and keep within budget,” Lars admitted. Instead the suffering of dental professionals would be officially recognised and form the basis of their remuneration. “It seems reasonable that those dentists that experience the most stressful situations as they deliver NHS care, should be the best rewarded.”
Politicians will always need statistics to justify their decisions, and they hope, demonstrate the success of their work. The team of non-clinical, multi-disciplinary experts have worked to develop an equitable system. Work situations will be allocated a score depending on the stress likely to be experienced. On this basis, missed appointments will receive no credit, as the developers expected dentists to spend the time chatting about their holiday plans, interfering on reception, or looking for snacks in the kitchen. Modest credits will accrue from examinations, but be enhanced by mitigating factors such as a complex yet vague medical history of the ‘I take six pills or is it seven? And you know doctor, the small pink ones whatever they are,’ type. Patient contacts where the medical history is met with ‘why do I have to do this yet again, you made me fill it in when I came last time in 2021?’ will also earn extra credits.
Higher level points will be awarded for recementing an ill-fitting bridge that came out two months ago, and appears since to have been run over, all in the last 15 minute session of a Friday afternoon, for a stressed bride to be, who is getting married the next day.
This will be a much more equitable system according Clus and Maud, that properly recognises and rewards dentists for their most challenging work.
Budgetary constraints will mean that overall contract values and clinical output will need to remain unchanged. This will be achieved through careful costing of the new points available for allocation. The only remaining part of the plan to be finalised is the name of the new stress related points, whose accrual will be linked to contract values. An invited clinician at the launch suggested Units of Dental Anguish.
“I like that,” responded Maud. “It will save a lot of editing when we prepare the new guidance and information material.”
The new scheme will start on April 1st 2025.
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