Practice Plan presents an overview of the current situation with NHS dentistry, to help dentists make an informed decision as to what may be best for their patients in the future.
Dental contract reform – prototypes
On 15 January, the Department of Health announced that a new stage of reform will start in 2015/2016. In this new prototype stage dental practices will test whole versions of a possible new system, rather than, as in the pilots, key elements needed to design a new system.
The prototypes will consist of:
• A clinical pathway
• A set of clinical measures (DQOF – Dental Quality and Outcomes Framework)
• Remuneration better aligned with access and clinical outcomes (a blend of quality, capitation and activity).
The prototype stage is intended to be a forerunner of a reformed system, but is not the final version. Wider adoption of the approach depends first on the prototypes demonstrating this is a viable approach.
Prototype practices have not yet been selected, with the process potentially continuing until 2019, the earliest date at which a reformed contract could become the prevalent approach.
In 2014, John Milne, Chair of the BDA’s General Dental Practice Committee (GDPC), spoke at a series of Local Dental Committees-organised roadshows offering valuable insight into the NHS contract, both now and in terms of what the future might hold.
A significant issue for the dental professional as a whole, is that the potential reform of the dental contract has been the subject of considerable discussion for many months now, with pilots continuing in 2015.
As Dr Milne noted at the 2014 Local Dental Committees (LDC) Conference and was subsequently reported to say on the LDC website: ‘…on-going pilots were not the finished article but were intended to contribute to a workable reform. He [Dr Milne] reminded delegates of his demands of the minister at the BDA Conference: some clear commitment from Government to make progress; expansion of the pilots and modifying them to make them into a real test to be some sort of prototype and a clear timetable and a roadmap to implementation. He had also said that practitioners would need preparation as part of training time for practices, and maybe a release from the UDA targets during the transitional phase. The Minister wasn’t able to confirm this last demand, but was able to confirm the first three.’
Dr Milne ‘…also reflected on some of the big questions GDPC had discussed around capitation contracts at their recent meeting and urged delegates to consider these and discuss them with speakers; e.g., what are the risks and benefits of arguing for the highest possible percentage of capitation? How do we avoid neglect? How do we monitor the capitation contract? Should there be a limit on who gets care? How should activity measures be paid for? How do we avoid the disadvantages of the UDA with its perverse incentives? Should payment for activity be limited to just advanced or complex care? And can we actually define what those things are?’
Practical application
So, what does this mean in reality for NHS dentists? For most of those working at grass roots level, thus far nothing has changed, but for the piloting practices, it has been an interesting journey.
For example, in July 2014 at the Westminster Health Forum seminar on oral health inequalities, dentistry commissioning, regulation, and the dental contract reform, dentist Sabrena Kara shared with the audience that the new system had led her to overcome a backlog in care by improving time management and using dental therapists to provide treatment, allowing her time to deal with more complex dentistry.
Other comments from pilot providers, published in last year’s report from the dental contract pilots evidence and learning reference group, include:
• ‘I think I could make it work better if I had a hygienist or therapist, that would make a massive difference because I could then you know, offload…I’m a very expensive hygienist at times really’
• ‘The patients are very positive… actually love it because they get such a lot of personal attention and they think it’s great, marvellous’
• ‘…to do the pilot properly takes longer… you’re talking to the patient more… I’m not saying that’s a bad thing but I just think it should be taken on board if we’re spending less time treating people… there’s either going to be a shortfall somewhere, there’s going to be complaints or there’s an element of people who might consider going somewhere else’
• ‘The throughput of patients has reduced and so there’s a pleasanter atmosphere. They’re [the dental team] not rushed off their feet like they were and it’s a more steady pace…they’ve had a little bit more work to do explaining to the patients about ICs and charges...I think they’re happier’.
These comments suggest that there may be a need to balance the time required to deliver the preventive aspect of the clinical pathway with treatment, but actually that isn’t anything new for NHS dentists. There is always a learning curve with anything new, and one hopes that results gathered from the ongoing pilots will help to make any transitions as easy as possible for the dental team.
Looking to the future
There is a general sense among the dental profession that we are most likely looking at the introduction of a reformed contract that will not drastically change, let alone improve NHS dentistry.
With patient care the focus of the current contract, and, presumably any reforms, for dentists happy with the NHS status quo of restoring the function of dental health in the most cost-effective way possible, the big question is whether the remuneration will be sufficient to run a viable business. Sadly, as has been the case for many years, the NHS is squeezed for funds and, much as we would all like to consider only the level of clinical care, no-one can hope to continue to run a non-viable business.
Nonetheless, NHS dentists have worked hard to ensure patients get the best possible care under the existing contract and, no doubt, will strive to do the same under a reformed model, if the parameters of what is on offer allows them to meets their clinical goals and the needs of their patients, while maintaining a viable business.
Practice Plan is the UK’s number one provider of practice-branded dental plans. They have been supporting dentists with NHS conversions for more than 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.
