Clawback Doomsday Approaches For NHS Dentistry
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- Published: Tuesday, 21 February 2023 16:53
- Written by Peter Ingle
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As the calendar approaches March 31st, many practices holding NHS contracts are struggling to hit their UDA targets. Practices bracing themselves for bad news have now received a hammer blow with the publication of details on the anticipated underspend, and how NHS England(NHSE) are likely to handle it.
The report in the Health Service Journal (HSJ) will make grim reading for practices that do not expect to hit the 96% mark. The primary dental care underspend is expected to reach a record high of about £400 million. To make matters worse, the money clawed back is likely to be diverted away from dentistry, to other parts of the NHS.
Data obtained by the BDA in response to Freedom of Information requests revealed the £400 million figure, which represents about 13% of the £3 billion primary dental care budget. Though this is more than twice the previous record underspend, NHSE have not disputed the BDA estimate. The BDA has outlined the massive scale of the problem. Their analysis of UDA delivery in the first 9 months of the 2022/2023 financial year has shown that many practices will not be able to reach their targets, with monthly UDA totals averaging just 75% of pre pandemic levels.
Jacob Lant, head of policy at Healthwatch England, described the situation as “an absolute scandal.” He observed that patients were, “paying the price for a dental contract that should have been ripped up years ago.” He argued that the money should be kept in primary dental care.
NHSE has confirmed that it will seek to recover “unused funding” from practices. Despite the ongoing access crisis, the NHSE chief finance officer recently said that unused dental funding could be diverted to plug some of the gaps in the new Integrated Care Systems, which expect to have a deficit of £500 million.
Reacting to the news, BDA Chair Eddie Crouch said, "Patients will struggle to comprehend why this Government is about to take hundreds of millions from the frontline during an access crisis. It’s not because there’s any lack of demand for dentistry, it’s simply that practices are working to a failed contract and can’t fill vacancies." Spelling out the likely consequences he added, "This will push dedicated NHS practices to the wall or to the private sector and leave whole communities with no options."
All of this comes in stark contrast to a recent government announcement attempting to ease the access crisis. In this, contractors were told that they would be paid for extra UDAs up to 110% of their target. It is unlikely that many practices will be both able and willing to provide extra UDAs. The offer may prove to be as cynical as last year’s “£50 million pounds for extra appointments” announcement, which at the time seemed unlikely to be taken up widely.
Belatedly, this latest news is understood to have prompted major concerns at a high level in NHS England. They might do well to listen to Nigel Edwards, chief executive of the Nuffield Trust think tank. Commenting on the news about the size of the underspend and its likely diversion from dental care, he said, “these regular (spending) shortfalls are indicative of the need for a fundamental and urgent rethink of NHS dentistry, what is offered, how it is commissioned and whether it can be made more sustainable. There are few reasons to be optimistic about this.”
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