Prospect Of New Contract Unlikely As Dentists In Prototypes Are ‘Thrown Under The Bus’
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- Published: Monday, 17 January 2022 08:18
- Written by Chris Tapper
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The British Dental Association has said that ‘Pioneering NHS dentists’ have been “Thrown under the bus” by the Government.
In October 2021, GDPUK reported that dental practices that had been participating in the prototype scheme exploring models for a new dental contract, had been told the prototype scheme was ending.
Over 100 practices in England were told abruptly that from April 2022, “All practices will return to underlying GDS or PDS contractual arrangements.”
The cessation of the prototype practice scheme has now delayed any prospect of the introduction of a new NHS General Dental Services contract, which many hoped would bring an end to the universally criticised UDA-based system.
After being given no choice but to return to UDA-based contracts or PDS agreements, BDA News said “The BDA has condemned the gulf in support offered to over 100 pioneering practices in England, who after years of testing new ways of providing NHS care, are being forced back to working to historic models of care from April.”
The BDA said “These ’prototype’ practices volunteered to form the test bed for new ways of delivering dentistry, to replace the widely discredited target-based NHS dental contract. In October they were informed that regulations supporting new ways of working would not be renewed.”
In a letter to prototype practices, signed by Ali Sparke, Director of Primary Care, Dentistry, NHS England said “We share your disappointment that the prototype contract has not proven to be suitable for widespread rollout, however the experiences of practices who joined the programme have offered important lessons to inform ongoing discussions on contract reform.”
“Reverting to existing models of care has taken up to four years for practices that have left the programme in the past. Practices are anticipated to face severe staffing problems, aggravated by already acute recruitment problems across the service. Many practices are already facing real issues with their long sustainability, hitting an 85% activity target the BDA believe are wholly unrealistic during this phase of the pandemic,” BDA News said.
Chair of the British Dental Association’s General Dental Practice Committee Dr Shawn Charlwood told BDA News.
"The support offered to these pioneering practices is too little, too late.
"Colleagues who volunteered to find a new and better way of delivering NHS dentistry have been thrown under a bus. After committing years of effort their reward amounts to a helpline, a few leaflets, and the uncertainty of starting again, effectively from scratch.
"These NHS practices were given the time to care that all dentists require. Going back to chasing targets could take years, and there will inevitably be casualties.
"Patients will once again pay the price for the reckless decisions taken by government."
It’s not fully clear why the prevention-based prototype practice scheme was abandoned
In 2018, an article in the British Dental Journal said that in the first year of piloting the new approach, dentists reported that “90% of patients had reduced or maintained levels of tooth decay, 80% of patients had reduced or maintained levels of gum disease and 97% of patients said they were satisfied with the dental care they received.”
England CDO Dr Sarah Hurley said “The announcement of up to 50 more prototype practices is an important step in developing the NHS dental service. I welcome it and hope that further refinement and testing with the profession will lead us to a model that enables dentists and their teams to play their full part in the delivery of integrated care and further improvement of oral and general health,” the BDJ article reported.
In June 2021, Dr Shawn Charlwood warned the Local Dental Committee national conference that NHS contract reform “Needs to be in place for April next year” (2022).
“I know that’s ambitious, but time is running out.
Dr Charlwood warned “The decade of delay and repeatedly kicking of the can down the road needs to stop.”
The despair NHS dentists feel about the current contract was summed up by BDA Chair, Dr Eddie Crouch, quoted on Twitter:
Across England, NHS dentistry is in crisis.
— BDA (@TheBDA) January 14, 2022
“Dentists have worked to a broken system that has singularly failed to recognise & reward commitment to the NHS” says @EddieCrouch
New targets could prove the final nail in the coffin.
A thread🧵https://t.co/uJ2Yu7ubL1
In the October letter sent to prototype practices, written by Alette Addison, the Deputy Director of Pharmacy, Dentistry and Eye Care, she said “As you are already aware, there were more concerning findings following consideration of the six aims for national contract reform to be viable as outlined in the letter to all NHS primary care dental contract holders dated 29th March 2021.”
“These include a fall in the numbers of patients able to access care, which mean that it is not possible to roll out the prototype approach more widely as we continue to recover from the impact of COVID-19 on dental services.”
It wasn’t clear what the ‘more concerning’ findings were, in the March letter referred to. That letter was signed by Under Secretary of State for Primary Care Jo Churchill, England Chief Dental Officer Sara Hurley and Executive Director of Primary Care, Ian Dodge.
NHS England said that contract changes must be designed with the support of the profession and should improve oral health outcomes. Other aims for any new contract were the establishment of a means to increase incentives to undertake preventive dentistry and improve access to NHS care.
Another requirement was the demonstration that patients are not having to pay privately for dental care previously commissioned as NHS dental care.
The sixth aim and perhaps the most significant, was that a new contract should “Be affordable within NHS resources made available by Government, including taking account of dental charge income.”
On the October announcement that prototype practices were being abandoned, Dental commentator Michael Watson said “If prototypes are reverting to UDAs in April, then everyone stays on UDAs and no new contract.”
“The only way for dentists to survive will be to convert to private practice.”
“To maintain some vestige of a general dental service, the Department of Health and NHS England will need to adopt a more modest system to treat those who really need treatment but can’t or won’t afford it. Call it a core service if you like.”
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