No Will, No Way - Analysing NHS Contract Changes
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- Published: Tuesday, 29 November 2022 07:38
- Written by Peter Ingle
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The recent Practice Plan Webinar looking at the latest NHS England (NHSE) dental contract changes did not make easy viewing for those practices hoping to continue delivering NHS dentistry.
Given Practice Plan’s core business, that may seem predictable, but the two of the three contributors had significant NHS commitment. Shiv Pabary is a member of the BDA GDPC Executive and a local adviser to NHS England. He was awarded an MBE specifically for his services to NHS dentistry in the North East.
Chris Groombridge is joint MD of the 543 Dental Centre in Hull, which offers a full range of NHS treatment to patients. He is also a director of the Association of Dental Groups who represent groups and corporate providers, many of whom retain a significant NHS commitment.
Nigel Jones is Practice Plans sales and marketing director, with previous experience that included working with a private medical provider that tendered for NHS contracts.
A major area for discussion were the present workforce challenges. The recent changes should, in theory, allow DCP’s to do more work through a changed skill mix. Challenges included the relatively small number of therapists currently registered, and the limited available training capacity. There were also issues about indemnity and who would “sign off” NHS forms, which remained unresolved weeks after the announcement. The panel estimated that it would take 7 to 10 years to get enough therapists in practice to make a significant difference. Current therapists, were not all keen to switch and would need support. Many had been “deskilled” after years working solely as hygienists. Shiv, who had integrated therapists in one of the axed pilots, felt that a dentists input would still be required for many treatment plans.
The added UDA bands were a particularly frustrating example of NHS England’s paralysis, with the first requests from the profession to add extra bands being made back in 2008, and then ignored for the next 14 years. It was noted that at the time of this discussion what had been described as ‘modest and rapid’ changes had still not all been implemented. NHS England wanted incremental change rather than full scale reform, but the pace was far too slow. Shiv wondered if NHS dental services were not so much at a tipping point as already tipped over.
There was a consensus that NHSE know just what needs to be done and possibly how to do it, but there is a lack of will to take any action.
Sorting out the GDC’s Overseas Registration Exam (ORE) bottleneck was crucial, with the dentists caught up in it, urgently needed in practices. Even with their deployment, Chris said that more dentists needed to be trained in the UK. NHSE wanted “magic solutions,” but the changes to ORE were unlikely to affect the market significantly for a couple of years.
In terms of delivering high quality care, Shiv bemoaned the lack of continuing care under the current contract, despite many patients still thinking of ‘their dentist.’ There was research to show that in general medical practice, continuing care with a particular clinician, improved outcomes.
The impact of the minimum UDA value was dismissed, with the observation that it would benefit, at best 200 practices. The gap between NHSE actions and reality was illustrated by the difficulties that even high UDA value practices were having recruiting. If NHSE thought a minimum value of £23 would attract dentists, they were under a misapprehension. Nigel spoke of high UDA value practices handing back NHS contracts because they could not recruit. Shiv observed that we needed a system home grown graduates want to work in.
In terms of what could be done to improve things, the increased interest and parliamentary questions from MP’s was welcome. The BDA had succeeded in framing the debate as being about the failings of the contract, rather than greedy dentists.
A “core” service was an option, but it had to be the government that decided who and what, it covered. They needed to own any reduction in the scope of NHS dentistry, and not be allowed to portray the changes as dentist driven.
The introduction of Integrated Care Systems (ICS) might not make much difference. They would only have access to clawback monies, so it would be difficult for a local group to outflank the national contract.
This was all keeping Practice Plan busy, taking on dentists in numbers not seen since 2006 and 2007, in the aftermath of the “new” contract. Shiv thought it possible that the government just wanted more patients to go private. The effects of abatement were putting many NHS practices in financial trouble and some might fail. Nigel observed that “fear of leaving the NHS” was much less of a worry for dentists now. Banks that worked with practices were taking an increasingly positive view of plans, after their relative resilience during the pandemic.
Perhaps the professions current attitude towards NHSE and their efforts to keep dentists on-side, was best illustrated by one questioner who found herself quoting Greta Thunberg. “It’s all just blah, blah, blah.”
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