Targets back with a vengeance in England despite stricter lockdown

Targets back with a vengeance in England despite stricter lockdown

Despite warnings from the BDA about the dangers of re-introducing UDA targets in the fourth quarter of 2020/21 and stricter lockdown for patients, the Government is pushing ahead with the imposition of a 45% activity target for dental practices in England. If they fail to deliver this percentage, clawback will apply, with draconian consequences for anyone achieving less than 36% of target.

The note was issued by NHS England in the names of Gabi Darby, interim Director of Primary Care Commissioning Transformation and Sara Hurley, Chief Dental Officer. It covers General and Orthodontic Contracts, Urgent Dental Care Centres, PPE and End of Year Reconciliation.

From 1 January to 31 March 2021 for NHS dentistry, practices delivering 45% of contracted units of dental activity will be deemed to have delivered the full contracted volume. In addition, COVID-19 related PPE will be provided free to practices.

The note says this arrangement “recognises constraints on practices seeking to deliver services safely and in line with current contractual guidance. It also recognises the need to best use NHS capacity for NHS patients.”

It continues: “We recognise there may be exceptional circumstances when this activity target may not be deliverable. Commissioners have discretion to make exceptions – for example, where practice staff are required to self-isolate or are affected by the reinstatement of shielding in tier 4 areas. This should be in accordance with the approach set out in section 6 of the supporting guidance published here. A dedicated helpdesk to support queries and questions can be contacted via the following email address: This email address is being protected from spambots. You need JavaScript enabled to view it..”

In a complex annual reconciliation process, contractors will be deemed to have delivered 100% of activity in the months January to March 2021 if NHS FP17s/FP17Os completed/delivered between 1 January 2020 and 31 March 2021 are 45% and 70% of usual NHS contracted activity for Quarter 4, for UDAs and UOAs respectively.

Where contractors deliver at least 80% of this 45% cumulative activity in January to March (ie at least 36% of contracted activity for this period), we will waive some clawback rights.

If a practice delivers X% of activity, where X falls between 36% and 45%, delivery will be deemed to be (X/45)%.

Where contractors deliver less than 80% of this 45% cumulative activity in January to March (ie less than 36% of contracted activity for this period), contractors will be deemed to have delivered only the actual activity delivered in the months January to March.

For the purposes of calculating activity deemed to be delivered, where the conditions in place in those months have been met, no actual activity for the months April to December inclusive will be taken into account in the annual contract reconciliation. Instead the deemed activity levels will be used.

Practices must make the following commitments:

  • Maximise safe throughput to meet as many prioritised needs as possible.
  • Remain open and prioritise care for patients who are considered at highest risk of oral disease, in line with the prevailing dental SOP and guidance.
  • Use NHS funding to the full for the provision of NHS services. Ensure full compliance to Clause 59 of GDS/PDS contract agreements – that practices will not advise that NHS services are unavailable with a view to gaining their agreement to undergoing the treatment privately
  • Continue preventative work (such as confirmation via the FP17 data that best practice prevention advice has been given to patients) and target efforts in a way that will reduce health inequalities (eg by agreeing to see irregular attenders as well as usual patients). This will be auditable by local teams with an expectation that practices will be able to provide evidence of their efforts.
  • Prioritise all known and unknown patients to the practice who require urgent dental care if contacted directly or via 111 services, as capacity allows.
  • Keep contractual premises open unless otherwise agreed via the regional commissioner.
  • Complete and keep under review all staff risk assessments.
  • Do not seek any duplicate or superfluous funding from the NHS or other government sources – including furlough or additional sick or parental leave pay that was not used to pay for cover.

In addition to the activity expectations, contractors will be asked to complete a declaration at year end to include:

  • completion of workforce risk assessments
  • completion of the monthly workforce return and retention of the workforce
  • declaration that payments during the 2020/21 contract year have been made to the practice workforce from April - December
  • declaration of proportion of NHS and private turnover
  • declaration of surgery opening hours and availability of NHS services
  • practice has an NHS nhs.net email address that is active
  • practice has not received any duplicate or superfluous funding from the NHS or other government sources – including furlough or additional sick or parental leave pay that was not used to pay for cover
  • practice has ensured that face-to-face urgent dental care is available for regular and non-regular attenders via direct contact or referral via 111
  • practice has reviewed any interrupted patient care pathways and restarted these where appropriate to do so
  • practice has ensured that patients who normally attend the practice are prioritised for care in terms of their risk.

https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C0958-issue-7-letter-q4-contract-arrangements-22-dec-2020.pdf

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