BDA Offers Its' View of the Future
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- Published: Thursday, 03 July 2025 10:13
- Written by Peter Ingle
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GDPUK recently covered one influential figure‘s view of how NHS dentistry might look in the future. At about the same time the BDA has offered a somewhat more dentist centric vision.
In Beyond the UDA: Where NHS dentistry goes next, General Dental Practice Committee Chair, Shiv Pabary, has written about the proposals the Committee has developed, and what he hopes to see in the next stages of reform.
These were produced with reference to responses to the BDA’s recent survey of dentists. The BDA point out that their consultation showed a strong consensus on multiple issues. Many of the proposals put to dentists received over 95% agreement.
There was strong support for a contract focused on prevention. English GDPs wanted a contract that is practical, financially viable and simple. In a similarly no nonsense fashion they wanted payments to reflect the costs of treatments, and for patients to know what is and is not available on the NHS. To achieve this the NHS would need to set a clear purpose for what the service is trying to achieve.
Shiv Pabary observed that Stephen Kinnock MP had been the first Dental Minister in decades to address a Local Dental Committee Conference. He believes that this sends a message, and was reassured to hear that the minister’s asessment of the state of NHS dentistry matched the reality seen in practices.
The minister had said that there was no one perfect payment system, however after nearly 20 years with the UDA contract there was clarity on what an imperfect payment system looked like. Contract reform had to deliver a fundamental break with the UDA.
GDPC had concentrated on what will deliver a prevention-focused system, which works for different patients and different treatment types, and makes the NHS an attractive place to work.
GDPC’s proposal to government has been for a contract that blends different types of payments so that the right funding and incentives are attached to the right types of patient care.
The Committee sees weighted capitation as the best way to pay for routine care. Patients value a long-term relationship with their dentist, and this can help in improving patients’ oral health. Weighted capitation can structure payments and care in a way that focuses on preventing oral disease, rather than just treating it once it develops.
Many patients still have high treatment needs, and as a group are often failed by the UDA contract. The proposal is that there should be more activity focussed payment for such treatment, probably based around an item of service model.
Those needing urgent care have also often been casualties of the UDA system. The time needed for each patient is unpredictable, along with the demand for such appointments, and patient attendance. Sessional payments have been demonstrated to address these challenges and have been one of the success stories from ICB commissioned schemes. This should be made the national model for urgent care.
Shiv Pabary agreed with Stephen Kinnock’s assertion that we should learn from experience.
He had worked at one of the 100 practices that prototyped a different payment system based largely around capitation. At its heart was a clinical pathway that did dentistry the way he was taught at dental school. The model had many things going for it that could and should be brought over to a reformed contract. For him the key thing was that a long-term relationship, focused on prevention, delivered results for improving individual patients’ oral health.
While there was potential to improve the prototypes, one learning point stood out, to scrap the UDA.
GDPC are ready to start negotiating now, and the ball is firmly in the Government’s court. They have made it clear to the government that they are running out of time. Dentists are already walking away from the NHS, reducing the number of UDAs they do, or leaving the profession. 85% of the survey respondents had said that in their opinion, in the absence of reform by the next election, NHS dentistry would not remain a viable service.
In the coming weeks, Shiv Pabary expects NHS England will bring forward changes to the UDA contract. While he hopes that they will deal with some of the worst aspects of the current system, it is not a substitute for real reform. “The UDA is not fit for purpose and must be scrapped altogether.”
Comparing GDPC’s vision with that of Lorraine Mattis, Chief Executive of the University of Suffolk CIC, shows some common ground. A focus on prevention, and a desire to reach those currently denied access to NHS dental care underpins both sets of proposals. There is agreement that major changes cannot be deferred any longer if NHS dentistry is to survive in a form recognisable to the public.
The GDPC approach is cautious and pragmatic, looking at specific groups and how to deliver their care by having the right type of funding for each of them, since they present distinct challenges.
But there are some major differences. Perhaps unsurprisingly, the BDA do not mention a therapist led service or focus on leveraging the entire dental team. The BDA vision is less radical and less challenging – it sets out a mechanism for delivering care in simple and familiar language, largely using current structures. Lorraine Mattis’s vision is lighter on the specifics of ‘how’ or ‘where’ but stronger when it comes to less tangible concepts such as silos and ‘distributed dentistry.’
There is another shared factor, and it is one that may see both visons locked in a fatal union. That is their apparent dependency upon improved funding.
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