Has outsourcing had its day?

outsourcingThe 2006 dental contract doesn’t work from a financial and business structure, Michael Watson says.

Last week dental news was dominated by the BDA Conference and Dentistry Show, which according to all I read did fantastically well.

I excused myself and am thus in no position to comment.

News outside dentistry was of course dominated by a happy event in Windsor, which again appears to have gone fantastically well.

But news from Parliament, when not dominated by allegedly bad behaviour by Mr Speaker and the seemingly endless debate on Brexit, was about outsourcing and Labour’s defiance of privatisation and a wish to bring more of our economy into public ownership.

Two backbench committees, commenting on the collapse of Carillion under a £1.5bn debt pile in January, said its board had presided over a ‘rotten corporate culture’ and was culpable for its ‘costly collapse’.

Former cabinet minister now back-bench MP Priti Patel said the collapse of the company should ‘remind us that the dominance of a small number of big players means that (small and medium-sized enterprises) often find themselves pushed out’.

She argued that they should be able to compete for and secure public-sector contracts.

NHS dentistry

I saw in this an echo in NHS dentistry where new contracts are more and more awarded to a small group of large corporates rather that small practices wanting to expand, let alone individual dentists.

Then there was the National Audit Office (NAO) report on NHS England’s management of the primary care support services contract with Capita.

The NAO said that the service to primary care practitioners, including the mismanagement of GPs’ and dentists’ performers lists, had fallen ‘a long way below an acceptable standard’.

Adverse reports, like London buses appear to come in threes, so also last week we had the collapse of the Virgin Trains East Coast franchise and the railway’s returned to the public sector next month as the London North Eastern Railway.

The reason, most commentators agree, is the operator was over-optimistic in its bid for the franchise, assuming it would recoup the money through increased passenger numbers, whereas in reality demand fell.

Is there not a parallel here with dental corporates who bid for contracts at low UDA values, then find the numbers don’t add up and they make a loss.

They, of course, can close the practice with staff put out of their jobs and patients forced to ring round to find another practice to treat them.

NHS England must then award UDAs at a more realistic value.

Read more from Michael Watson:


Without wanting to sound too much like an opposition MP, the three cases brought before parliament the outsourcing foundered on the need to make money rather than provide a service.

You can well argue that, since 2006, the model of general dental practice in the NHS likewise is not working and I am not talking about UDAs, but more fundamentally its underlying financial and business structure.

The Labour Party and the unions say the answer is in nationalisation, but general dental practices, and the rest of primary care, has never been nationalised and would, arguably do worse if all dentists were employees of the state.

So, I return to my quote from Priti Patel MP and ask whether, in dentistry, the dominance of a small number of big players means that the small practice and the individual practitioner ‘often find themselves pushed out’.

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