Targets, standard operating procedures (SOPs) and the impact on dentistry

increasing NHS targetsNigel Jones recently caught up with Eddie Crouch, chair of the BDA’s Executive Committee, to discuss the late UDA target announcement and its impact, potential SOP changes and recruitment issues.

A lot has changed in the short time since we last caught up. The major change has been the uplift in the UDA targets from 60 to 65%. So, firstly, what’s your overall thoughts on the new target?

EC: I think NHS England is wanting to push for a much higher percentage to be honest. And I think the vast majority of NHS dentists seem quite relieved discovering it was 65%.

We were at a point where the NHS was coming under a lot of pressure to announce something. They were looking for the best possible percentage that allowed dentists to see more patients. However, they couldn’t go any higher, because we are still very much in a pandemic.

As we know, there have been no changes in the SOPs, and no change to IPC guidance. At a time where statistics are showing that a number of practices are still struggling to hit 60%.

Some have managed to do it quite easily. But a significant number aren’t getting anywhere near it. And to make it harder for them to achieve their target when nothing has changed seems completely illogical.

So, for me, there was no reasoning behind the 65% whatsoever. The only thing I can think of is that the NHS probably thought it was a figure that would create the least noise.

The major issue with the announcement was how late it arrived. What was your opinion on why it was so late, and how it was received by the dental profession?

EC: First of all, I think it just showed how unimportant dentistry is to the NHS. We all received the news at 7pm, after all practices closed. NHS England had six months to negotiate this and get the information out.

The last time this happened was Christmas last year. We at the BDA got so frustrated that we broke ranks to release the information. That didn’t go down too well.

With the recent target announcement, they’d been negotiating for six months. During this time there were a lot of meetings with chair of the BDA’s General Dental Practice Committee, Shawn Charlwood.

I know towards the end, a lot of the process meetings were cancelled at short notice. It seemed pretty clear there were internal struggles going on within NHS England over the new targets.

It could have been signed off weeks before by the NHS hierarchy. But again, it was a last-minute job and that was unacceptable.

If you really want to cheese off a profession that are already pretty cheesed off, then that was a good way of doing it.

In my 37 years as a dentist, I have never known so many in the profession putting their futures with the NHS into real question.

What we didn’t see included in the latest announcement were any changes in the SOPs. Do you think they are going to come anytime soon?

EC: With the SOPs I do expect there to be somewhat of a delay. We were expecting guidance by the end of October. However, I would be surprised if IPC guidance changes before the middle of November. And to be honest, it is more likely to be the end of November.

A lot can happen between now and then though. We are seeing COVID cases continue to rise on a daily basis. So that is going to have an impact on any decision that they make.

I believe it would be inappropriate to start relaxing things in dentistry at a time when the government is talking about re-introducing restrictions.

We recently had an IPC consultation on changes. The feedback from dentists was very mixed.

Some are desperate to get rid of PPE and are happy to screen patients in a way that allows them to wear normal levels of PPE. However, there are other colleagues who are quite worried about them and their team. They aren’t comfortable to make adjustments just yet.

The team who are in charge of deciding whether to relax SOPs have a very difficult job. They have huge political pressure on them to make it easier for people to see a dentist in higher numbers. However, I do trust the integrity of those dealing with this to do it in a safe manner.

Another big issue is the struggle to recruit associates and nurses in the NHS, with private practice presenting a more attractive offering. This comes at a time when pressures and targets are on the rise. What’s your view on the situation Eddie?

EC: Well, the doctors and dentists review body report came out and recommended a 3% uplift in dentists’ pay. Many dentists haven’t seen an uplift for such a long time, and with this one, a lot won’t even see it because the running costs are going up.

In Wales, they’ve given an uplift of 3% on the contract on the understanding that they are expecting those practices to pass that on to associates. So they will all get an increase in their pay.

But here we are in the final quarter. And there is still no idea when the implementation of that contract uplift is going to happen.

In the meantime, you’ve got associates, foundation dentists and other staff that have left the profession. They can’t see an increase in their wages coming up.

The current pay situation is another slap in the face for the workforce. The question is, how many more slaps in the face will the profession’s workforce take before the majority up and leave.

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