The impact being in a prototype has had on my practice and patients

What better way to know more about how the contract reform process could impact you specifically, than asking someone who has spent years trialling it?

Len D’Cruz is currently running a prototype B practice – one of the remuneration blends being tested as part of the reform process. He will be appearing on a panel of peers at a What Next for NHS Dentistry? event on 12 June where dentists will be able to hear about his first-hand experience and ask him, and the other panel members, questions.

Also on the panel will be Eddie Crouch, vice-chair of the BDA’S Principal Executive Committee, Nick Barker, owner of a prototype B practice, and Tina Tanna, a mixed practice owner.

Ahead of his appearance at the event, Zoe Close spoke to Len to hear his thoughts on the contract reform process.

Zoe Close (ZC): How has your experience as a prototype practice been?

Len D’Cruz (LD): We have managed to retain our contract value this year by exceeding the capitation patient numbers but under-delivering on the UDAs. We have done this by a very structured approach, zoning the appointment books to ensure the right number of patients are seen to keep up the numbers. We have expanded the practice and now have street-level shop frontage, which has attracted more patients.

ZC: What impact has it had on your profitability and workload, and how have you met those challenges?

LD: We have maintained our profit over the last few years, though our patients are having to wait considerably longer for band two treatments – in some cases two to three months. This is a poor reflection on the type of service and access we would wish to provide but we are limited by time and space.

We have, in fact, for the first time ever in the 25 years I have run the practice, stopped taking on new NHS patients. We are subsidising the hygienist service by providing a service on the NHS with no extra funding.

ZC: What impact has it had on your patients’ oral health?

LD: We believe the oral health of our patients has improved and that we are able to spend more time on prevention.

ZC: In what way do you think the different prototype blends suit different types of practices?

LD: The key to the success of the rollout will be to ensure that as many practices as possible, of different sizes and in a range of demographically different areas, can actually survive and thrive. The fact that it has not been rolled out is a testament to the fact that the government recognises that economic stability of practices is dubious.

Our practice has survived simply because we are in a leafy London suburb and patients often elect to have treatment done under private contract. That is the only reason we have survived. Many colleagues in high needs areas struggle to make the prototypes work.

ZC: What are your thoughts on how the contracts may be rolled out from April 2020?

LD: It is unlikely that the profession or the NHS commissioners are ready to roll this out. Practices will need to make a choice about sticking with the current UDA contract or rolling into the reformed contract. Most practitioners don’t know enough to make a rational business decision. It can be quite destabilising and will create long waiting lists for practices that are not comfortable with them.

ZC: What advice do you have for practices that are either wholly/partially NHS in terms of how they can prepare for contract reform?

LD: I would suggest that if they are hitting their UDA targets comfortably they might be advised to stay where they are. If they are struggling to meet the targets, this may be a better way of working for them if they have a stable, low needs population.

To hear more from Len, you can attend a free event where he will be part of a panel of dental experts discussing contract reform and the future for NHS dentistry. The What Next for NHS Dentistry? event takes place in Gatwick on the evening of Wednesday 12 June.

There will also be another What Next for NHS Dentistry? event held in Manchester on Wednesday 19 June.

For more information or to book your place, click here.

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