Nigel Jones breaks down the intent behind incoming changes to the NHS dental contract and what their impact might be in practice.
We are rapidly approaching the start of a new financial year, and many dentists in England and particularly Wales will be steeling themselves to wrap their heads around the latest minor/modest/major/futile (delete as appropriate) changes to their contractual arrangements with the NHS.
Of course, the devil will be in the detail and considering the consequences of the changes, intended and otherwise, will take time; time that will be in short supply given the lateness of the hour that said detail is being provided.
And some will find themselves staring at the same page blankly, feeling none the wiser and thinking that this isn’t what they signed up for when they chose dentistry as a career. Which begs the question: what did you hope you were signing up for?
That’s not as trite a question as it might at first sound. Many might say something like ‘the opportunity to have a tangible, positive impact on people’s lives and developing skills while being appropriately rewarded in a way that allows for the right blend of work and play’. Sounds plausible, sensible and laudable.
But what impact? Pain relief or improved self-confidence? Which people? The advantaged or disadvantaged? Which skills? Clinical, interpersonal or small print interpretation?
A moment to reflect
I realise that the above is an oversimplification of what should be a many faceted answer to the question. However, the point remains that now is a good moment to reflect on what drew you to dentistry in the first place and not to simply adapt, yet again, to the ever-rising temperature of the NHS waters (check out the boiling frog analogy if you are unsure about that reference!).
This isn’t just a binary point about private dentistry being good and NHS dentistry being bad. Reducing oral health inequality will be a huge motivator for many involved in UK dentistry and the NHS has a vital role to play in achieving that aim. It follows therefore that, for some, it is vital to thoroughly understand those new contractual arrangements to avoid being unnecessarily constrained by a lack of confidence or inaccurate assumptions.
Of similar importance will be the need to think through the long-term implications of the changes. Take, for example, the priority being attached in England to ensuring the whole population has access to a dentist in an emergency. To this observer, it feels that those last three words are increasingly politically important.
Compelling a practice with an NHS contract to dedicate an agreed proportion of time to strangers directed to it by NHS 111 might be entirely in keeping with the vision of the owners in respect of the active role they seek to play in the local community. At the other end of the scale, knowing so many practices use private income to subsidise NHS care for pre-2006 selected patient groups, this could be akin to allowing a pop-up McDonald’s in the middle of The Ivy.
‘More challenging in reality than in a spreadsheet’
If the intent behind the new care pathways in England is to reduce barriers for high needs patients, that is to be applauded, and some practices will undoubtedly benefit financially. However, the sense of robbing Peter’s practice to pay Paul’s is hard to escape given the unused dental budget for 24/25 fell to £36m and there will be no additional funding.
The impact of the renewed focus on NICE guidelines in respect of recall intervals will be interesting. The appeal of creating additional capacity by eliminating unnecessary appointments is understandable although the maths may be more challenging in reality than in a spreadsheet.
In Wales, some practice owners have suggested it amounts to the creation of a core service by stealth as it disadvantages practices with a stable, regularly attending patient base with a higher average socio-economic status. The result, they anticipate, will be more contracts being handed back.
Others are viewing the publicity and strengthened enforcement of NICE guidelines as an opportunity to persuade motivated patients to pay privately for additional appointments. That’s unlikely to be a problem financially for the NHS, but what will it mean for clinical capacity? Those private appointments are still occupying surgery time, and the shortage of FTE clinicians means extending opening hours is rarely an option.
Compromises
With these contractual changes in England and Wales comes a lot to think about. There will undoubtedly be those who, by taking the time to get fully immersed in the details, will make the new look NHS contracts work better for them than others.
For some, this could also involve compromises to patient care or, more likely, to their personal health and wellbeing. However, such compromises may be viewed as a price worth paying in pursuit of that goal of reduced oral health inequality.
For others, too much energy has already been wasted on the intricacies of contract interpretation, the management of legal risks and skewing their personal career vision to fit with the requirements of the NHS.
The important thing to remember is that the current imbalance between the supply of clinical time and patient demand for dentistry means that in most scenarios, dental professionals in England and Wales have choices and don’t need to feel bounced into a decision. As Jake Abel has said: ‘No choice is the wrong choice as long as you make a choice. The only wrong choice is choosing not to make one.’
There’s never been a safer time to leave NHS dentistry. If you’re considering your options away from the NHS and are looking for a plan provider who will hold your hand through the process at a pace that’s right for you, you’re in safe hands with Practice Plan.
You can start the conversation today by calling 01691 684165 or booking your one-to-one NHS to private conversation at a date and time that suits you, just visit practiceplan.co.uk/nhsvirtual.
This article is sponsored by Practice Plan.
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