Dental contract reform – are we making progress?

Are we any closer to dental contract reform?Flexible commissioning with a new dental contract will allow dentistry to move outside of the dental practice, Michael Watson says.

It was ‘sell-out time’ at deputy CDO Eric Rooney’s talk on GDS dental contract reform at BDIA Dental Showcase.

Understandably dentists and their teams want to know what is going to happen to them and when.

The Office for the Chief Dental Officer (OCDO) stand had a leaflet containing frequently asked questions (FAQs). It also directed you for further information to the BSA website.

The FAQs stress that the government commits to reforming the current NHS dental contract.

Dental contract reform

Indeed it has been ever since December 2010. This is when the then coalition government published its proposals for piloting a new dental contract.

In a foreword to that paper, the then Health Minister, Lord Howe wrote: ‘Until now, the NHS dentistry contract has remained focused on treatment; there has been little or no incentive for dentists to practise the sort of preventative dentistry that most people today want and need.’

He added: ‘It is time for this to change.’

Nearly nine years later the large majority of the profession are still waiting for this change.

Despite pilots and prototypes there are no decisions on national roll out. Nor criteria to work out contract values, how the capitation element is weighted to reflect oral health locally and critically how patients’ charges are imposed.

General election

First year prototyping evaluation was published in May 2018. The results of the second year remain under wraps.

Replying to a Westminster Hall debate back in July, initiated by Tim Farron MP about poor patient access in Cumbria, the then junior Health Minister Seema Kennedy MP said that 102 practices are testing the new ‘prevention-focused’ way of delivering care nationally.

She added that NHS England was ‘considering carefully’ when the new approach is rolled out more widely across the NHS. Adding that it is important ‘we get the new contract right’. However, she was hopeful the roll-out will happen as soon as possible.

Shortly afterwards moved on and has now said that she will not be standing in the forthcoming general election.

Parliament is now dissolved and all activity at Westminster has stopped. This includes the inquiry into NHS dentistry by the Health Select Committee.

Members of Parliament are no longer MPs, although ministers stay in office.

The civil service, including agencies such as NHS England, go into period of purdah, so they won’t even tell you the time of day, for fear of influencing how you vote.

What does a reformed dental contract look like?

The elements of the blended contract, the basis of any change, are on the NHS BSA website.

It is a blend of capitation and activity payments.

Blend A includes B and one treatments (examination etc) in capitation but all else (including fillings, extractions, crowns and dentures) as activity payments.

Blend B brings non-lab treatments into capitation, with crown and denture work paid through activity payments (UDAs).

The care pathway approach, which lies at the heart of the prototypes, aims at ‘promoting a long-term preventive approach based on individual need and risk’ and ‘encouraging patients to take responsibility for protecting and maintaining their own oral health with support from the practice dental team’.

As such it will be most suitable for practices with a stable base of regular attenders, but one must bear in mind that the latest stats from NHS Digital show that only 50% of adults have seen an NHS dentist in the last 24 months and 60% of children have been in the last 12 months.

Flexible commissioning

Some practices will struggle and some patients won’t get the care they need.

This brings us back to what the previous minister said about ‘so-called flexible commissioning, which allows local NHS commissioners to commission a wider range of services from dental practices’.

This should allow add-ons to the contract, additional mini-contracts if you like.

These could include dental team members going out into schools and care homes, care for people with dementia, the vulnerable including homeless and older people living on their own and most recently in the news people with diabetes.

In the future not all care is delivered only by dentists and only in a practice setting.

If my suppositions are correct then it would suggest a more gradual roll out. A roll out where change makes practices more financially stable and where oral health across the population is improved.

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