Is NHS dentistry still viable?
Neel Kothari talks about the latest NHS dental targets and why it has meant practices are stuck between a rock and a hard place.
Recently NHS England announced that quarter three will be exempt from clawback providing 65% of the contract has been met. In that letter they made it abundantly clear that a condition for this was that practices should not prioritise patients of lower clinical needs over those with higher clinical needs.
The precise words used were: ‘As there is no patient registration within dentistry patients must be prioritised against clinical need and priority groups regardless of whether the member of public is on a practice’s business list or not – this is a condition of ongoing financial support.’
So, are ongoing payments for lower targets ‘COVID-19 support’ as the NHS suggests? Or payments for a new way of working?
The request to prioritise high clinical need groups seemed most appropriate and achievable when the threshold was 0%, 20% and at 45%. But the NHS’s own reported data indicates rather disastrously only 63% were expected to achieve or exceed the 60% threshold.
This raises the question; can dental practices afford to ignore their offensively termed ‘business list’ without the security of guaranteed pay?
Further, it’s expressly stated within the GDS contract under term 71 that: ‘The contractor shall provide services under the contract in accordance with any relevant guidance that is issued by the National Institute for Clinical Excellence, in particular the guidance entitled “Dental recall – recall interval between routine dental examinations.”‘
This seems to conflict with the recent NHS letter that infers a lack of registration is synonymous with no ongoing obligation to provide patient care. It is and always has been that NHS dentistry has provided access to anyone seeking care under its auspices. Attempting to reinterpret nGDS poses several obvious problems.
Firstly, patients don’t care about terminology, they simply see themselves as being registered with their practice; attempting to change this lends itself to increased confusion and complaints. Secondly, it’s practically impossible to reach 65% without prioritising regular attenders. Patients with higher clinical needs will take up more chairside time.
Finally, how do we determine who has a higher clinical need? Well, unless patients have had an exam and risk assessment, we cannot really know who this would apply to. Remote triaging is impractical for this sort of determination.
Damned if they do and damned if they don’t
Simply put, this means that NHS providers are damned if they do and damned if they don’t. On the one hand, abandoning their existing list of patients and prioritising high risk patients means that most will almost certainly fail to meet 65%. On the other hand, continuing operating out of a ‘business list’ runs the risk of significant clawback.
The ugly truth is that NHS dentistry has been failing for many years and has only survived due to the ability of our profession to make it work. In 2006 the government took control of NHS dentistry away from dentists and their commissioning record has since been abysmal.
After years of neglect and allowing NHS dentistry to decay, we are now faced with a toxic mix of immense demand for NHS dentistry from patients, a political desire to increase the throughput of patients without additional funding, as well as an unprecedented number of practices no longer accepting NHS patients.
Asking dentists to deprioritise low clinical need patients doesn’t seem like a variation of nGDS. But rather an entirely new way of working. This is one which is being imposed upon the profession in an employer/employee style relationship rather than with its consent.
Years of underfunding for NHS dentistry
This isn’t the fault of ‘greedy dentists’ or practices trying to maintain a ‘business list’. This is the result of years of chronic underfunding and an experiment in the form of nGDS. This has now well and truly failed.
This experiment has made a few within our profession incredibly wealthy. But has reduced the role of the majority from the respected title of ‘associate’ to that of a mere ‘performer’.
Now the dental profession is being asked to abandon their loyal patient base who has stayed with them through thick and thin. Instead it is asked to favour potentially irregular attenders, in the hope that this will solve the NHS dental crisis.
This isn’t a carrot and stick situation. This is well and truly a choice between a rock and a hard place.
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