It was the 15th January 2010 when I was part of the first contract meeting at the DoH and 11 months later we have had the announcement of the pilots this week. Members of the GDPC have been working in the five work streams, which were devised originally by Labour in response to the Steele Review and the Health Select Committee that was so critical of their changes to NHS Dentistry.
The makeup of the groups have included GDPs including GDPUK member Alisdair McKendrick, other invited GDPs and an array of people involved in Primary Care Dentistry from Consultants in Dental Public Heath, to PCT commissioners and BSA staff. There have been many Civil Servants co-ordinating meetings and attending, including the “money men” who I will return to later.
My position was on the Contracts Group, which was challenged with designing contract types to fit into the accepted review conclusions of Prof Steele. The group was ably chaired throughout its work by Deputy CDO Sue Gregory. It was clear for all to see that Sue wished the whole process to be open and transparent, I am sure some Civil Servants aligned to nGDS and Labour spin would have wished to take control, but as was evident from Sue Gregory’s comments at LDC Officials Day, she had concluded nGDS a failure, and such work needed someone who understood that. During the transition of Labour to Coalition the work has changed to fit in with the political policy with a redrawing of the map towards outcomes instead of activity targets.
Interestingly the finance group never met, well not with the people who were assigned to the workstream and the GDPC representatives. I have no doubt the finance people within the DoH have met often and reacted to what the other work streams were producing.

GDPC, under the Chairmanship of John Milne had agreed engagement with extreme vigilance, and I am sure that is what all GDPC representatives on the working groups have tried to bring to this project, but that vigilance must continue. Selection of the pilot practices must not be restricted to the PCT “favourites”, this contract must work for all contractors and patient types if it is to be successful. Evaluation of the pilots must be honest and have the confidence of all that are affected and not based on what the DoH perceives a success.
The work during the contracts group has been influenced by the Oral Health Assessment (Red, Amber, Green traffic lights) developed in Salford. It’s advocates proclaim the potential benefits and clearly in the hands of the committed it has some interesting features, but will it work when spread more widely. Well the positive thinkers will say “that’s what the pilots will test” and we shall see.
Clearly it might work well with the correct funding, but I understand some practices in Salford have not been so successful with similar schemes where funding has clearly proved inadequate in a high needs area and the UDA values and other payments clearly affect success and failure.
But that’s where the money men come into play and as we all know protected NHS funding is proving hard for the coalition to protect. They have discovered holes all over the place in budgets and as I said in last month’s article, if you were planning pilots now is not the best time to do it. 4% effeciency savings in primary care demanded, wage freezes in secondary care and PCTs struggling to save 40-45% of budgets, austere times indeed.

We must be careful how DoH accountants work out “national capitation figures” and how carrying out private care at the patient’s choice will affect the capitation payment. These money men are also twitchy about capitation producing vastly reduced clinical activity and made efforts during the process of planning the contracts, to try to produce a list of expected activity, but hopefully this has been successfully rebuffed.
Running capitation pilots for a period of 12 months will not produce evidence of success or failure but will only point to how patients and dentists start to be influenced by such a contract, but we must all resist knee jerk reactions, sadly the time scales will be dictated to fit with the White Paper hopes of the Coalition and dentistry will just have to match the time frames.
Once concluded we enter the difficulties of transitional arrangements transferring nGDS contracts into new arrangements and protection of the “losers” in such changes.
We have seen the dental budget attacked by financially afflicted PCTs , here in Birmingham we have lost £3 million recently of supposed ring fenced money as a result of PCTs pulling new access contracts when Chief Executives realise it’s easy money to divert into other pots, claw back money has been used this way too.
When 2014 produces new contracts the DoH are adamant there will be no new money, we have already lost substantial amounts of the apparent new money that was meant to be added to the budgets of 2006. In the times we are in, it’s hard to see how capitation if successful in pilots will get the money it will need to make it successful countrywide.
We are about to take off in the spring, where will we land, and when we get there will we have enough to spend?
Eddie Crouch

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