Why the 2006 contract needs to change

Dentist Kris Leeson considers the problems with the 2006 contract and contemplates how a revised contract and/or private practice may improve the situation for dental healthcare professionals and patients alike.

Kris Leeson, BChD Leeds, MJDF RCS Eng, MSc (Implant dentistry), graduated in 2005 from the University of Leeds and is the principal dentist and owner of Thorpe Dental Group York, a mixed practice. Kris has a special interest in the treatment of anxious patients and has gained extensive experience in the use of intravenous sedation. He also has a special interest in dental implantology, and completed his Master’s degree in implant dentistry from the University of Warwick. In 2013 Kris achieved his Royal College of Surgeons qualification. In addition, in December 2012 Kris was crowned winner of The Dentistry Awards Best Young Dentist North East.

Why does the 2006 contract need to change?

It’s a good question with no easy answer but I, like many of my colleagues, have my own view of the situation.

Back in April 2006 when the contract came into being I was still in my VT year, finishing late that summer. It was quite scary for me because my career was starting by stepping into the unknown. In my VT year I was involved with a contract that was basically a piloted scheme. It was like the new contract but without UDAs; you could do whatever you wanted.

From the start I wasn’t happy with the contract and I was in the fortunate position to be able to buy a practice straight away and, in fact, bought the practice in which I had completed my VT. I personally moved away from NHS work, although the practice was, and remains, mixed. For me, the system was inequitable as PCTs varied in how much funding was available. Mine offered me a contract but the funding was unequal to the task. Financially it was impossible to achieve; however, I do recognise that I might have felt differently elsewhere, if a different PCT had been involved.

However, my biggest problem with the 2006 contract is the UDA system. First of all, for example, a band 2 course of treatment is worth 3 UDAs whether you perform a simple occlusal amalgam filling or molar endodontics, which just doesn’t make sense. In addition, from now until April, many NHS practices in this country will need to cram UDAs in to meet their targets. Is that good for the patients? If you do it the other way and see as many patients as possible at the beginning of the year, by the end of the year you can’t see patients because you won’t get paid for it. That side of the system is ridiculous; it’s an organisational nightmare. The NHS expects us to hit 96% of the target and it’s so difficult. You don’t know what’s going to come through the door every day and it’s impossible to get that balance right. We have a small contract and even that’s very difficult. 

What’s next?

Beyond the organisational aspect of UDAs, for me the biggest issue is that there is no payment for prevention or patient education. But it looks like the next contract might remedy that situation. In theory, we’ll have capitation, more time with patients and a simple traffic light system. We do need to work on prevention and spend time with our patients, which will reap rewards in the future.

If the proposed contract, as I understand it, works, it sounds like it could be fantastic. The issue is how it works. Take the computer system for example; it will be different, we’ll have to input a lot more information and first appointments will need to be longer. Where are all the patients going to go? Some of my NHS dentists are booked for the next three months, so imagine the waiting list if appointments need to be longer.  They’re going to be booked up for the next year just doing check-ups.

That leads me onto another of my concerns; that the revised contract, as a preventive scheme, does not financially lend itself to being associate-led.  As a practice owner, I don’t need to pay a dentist to educate patients on their oral health. I can employ a dental therapist who can do the job for less money. Where does the associate dentist fall in this scheme? I would prefer an associate in there, but am I going to be able to pay an associate to do that job if the focus is on oral health and prevention? As always, money is a big issue. How could it not be?

Making it work

Dentists are very good at getting used to a contract; we are adaptable because we have to run our own businesses in a very stressful situation. We get what we’re given and we try to work with it in the best interest of the patients and our livelihood.  The 2006 contract doesn’t balance those two elements and things get missed. What we want is something that will help with the prevention side of dentistry. Capitation with some sort of target and some monitoring is needed. Whatever we’re given we will work with it, as long as it doesn’t hit us financially.

It’s my livelihood, but the contract is changing to be better for patients; it’s not about making things better for dentists. If it isn’t affordable for me then I’ll have to convert to purely private dentistry straight away. I can’t do the same work – or more – for less money.

There is, however, definitely a place for mixed practice. I actually don’t think purely NHS practices exist. There are plenty of NHS dentists with NHS patients on their books, but they offer a private element if those patients want something beyond the contract.  For example, if a patient asks for cosmetic replacement of an amalgam filling you’re not going to do that on the NHS because it isn’t clinically indicated. A patient pays privately for that filling because they’ve requested it. So there you have a mixed course of treatment.

In summary, in my opinion the 2006 contract needs to change because the system is financially inequitable, there is no payment for prevention or education and UDAs are an organisational nightmare. Hopefully, the answer lies in the next NHS contract and if I get a fair deal then I’d be happy to carry on in mixed practice. But if the new contract does not address the fundamental issues, then I will have to seriously consider moving away from NHS dentistry.

Practice Plan is the UK’s number one provider of practice-branded dental plans. They have been supporting dentists with NHS conversions for over 20 years, helping them to evaluate their options and, for those who decide to make the change, guide them through a safe and successful transition to private practice. So, if you’re thinking about your future and would like some expert advice you can trust, then call 01691 684120 or visit www.practiceplan.co.uk/nhs