Nigel Jones, Chris Groombridge and Simon Thackeray discuss the confusion surrounding the unscheduled care element of the updated NHS dental contract in England.
On a recent Practice Plan webinar hosted by director Nigel Jones, dental practice owners Chris Groombridge and Simon Thackeray were inundated with questions about the unscheduled care element of the new NHS Dental Contract for England. Here’s a snippet of their discussion. The full webinar is available to watch here.
Nigel Jones (NJ): We’re together because there is a huge demand from practices for information about the new contract. Chris, I suspect that you’ve looked very carefully at what the detail is so, could you explain how you see things, please
Chris Groombridge (CG): What’s happening in simplistic terms is 8.2% of the contract that you currently have will become for urgent care and the remaining 91.8% will be for routine care. So, you’ll have two targets and you will have to deliver a minimum of 96% on both. So, that is what is fundamentally going to change.
Obviously, routine care will be slightly reduced by 8.2% and urgent care will go. Having said that, most practices deliver an element of urgent care. The Department of Health itself believes that’s about 7% nationally, so it’s a slight increase for practices. It’s not so much about the percentage. I think 8.2% is quite a fair – a sensible figure. It’s the impact that the direction of travel is going forward and what that says to the profession and to patients. I think that’s something else.
NJ: And the 8.2%, Simon, my understanding was that the government was pushing for a lot more than that and the British Dental Association (BDA) did a pretty good job of containing it
Simon Thackeray (ST): Yes. I think the BDA has done a fantastic job. I’ve been a critic of the BDA at times, but I sit on the GDPC (General Dental Practice Committee) and they’ve been the people who have negotiated via the executive. I suspect that the government probably wanted something in the region of 25%.
Of course, it depends on how you define ‘emergency care’. This is not just urgent care – the government is calling it ‘unscheduled’ care. So again, this is going to be one of these things where the devil is in the detail.
‘Unscheduled care’ for me is the patient who came in today for a crown resub who was one of my regulars. Or someone who needed reassurance out of their normal times such as: ‘I’ve got an ulcer that’s not healing up after two weeks.’ That kind of thing.
We’ve trained a lot of our patients quite well and when you look at that, I don’t think 8.2% will be a difficult target for a lot of practices to reach. In fact, you might find that they do more than that. Of course, when that happens effectively this is now going to eat into your normal or your second target, which is your routine care.
CG: I’d like to point out that you can over-perform on the urgent care target which in turn feeds into your routine, but you cannot do it in reverse. This is targeted at your own patients, which you can focus on and 111, it’s a combination. The appointments can be slotted anywhere, which is far better than blocks.
Time blocks versus adhoc appointments
GC: What they originally proposed was blocks. If you work out what the DNA/FTA (did not attend/failed to attend) rate of £15 means, that £15 equates to roughly five minutes of surgery time. So, if you’d done blocks, you’d end up with a £75 loss per DNA. It just doesn’t make economic sense. By allowing you to slot them in where you want, that makes the DNA rate suddenly a viable option.
ST: It’s going to be better than it has been. Although £15 pounds is still an insult. It’s nowhere near enough and especially if you are blocking it out and you run your books with a half an hour unscheduled slot every day. If you’re sensible, you’ll do it just before lunch so you can have a longer lunch break.
One of the issues will be who has access to getting those patients in? There has been talk about giving the integrated care board (ICB) access to your appointment book and they can book this type of appointment. This isn’t on from a data protection point of view. Some people will be concerned that this might be the intention. You know as well as I do, Chris, some of the ICBs aren’t necessarily consistent in the way that they deal with things. So, it wouldn’t surprise me if one ICB goes rogue and says: ‘Right, we want access to your computer system so we can book those patients in.’
CG: The gist of what will happen is the ICB will approach each practice, and they will agree some regular times to slot 111 patients in. Equally, you can just focus on your own patients, and you might be able to deliver the target of 8.2%. A lot of practices will look to do that. That means the slots will vary as it will be ad hoc to maximise appointment space and minimise DNA. Inevitably that means where they put those patients will be varied for a lot of practices.
NJ: So, Chris, in the press it says about providing 8.2% for urgent care. Is that going to be on patients registered at your practice or will you have to take on new patients for that part of urgent care? Now I think you’ve suggested that you don’t have to take on new patients, but how will that work? So, if 111 phones up and says, ‘we have a patient that needs to be seen’, what will happen?
CG: That will be a conversation between you and the ICB. The Department of Health and Social Care is working out what 8.2% looks at with the ICBs at the moment. They will then in turn contact you, at which point you will know whether you’re going to be able to achieve it on your own patients, or you’re going to take a combination of 111 and your own patients, or solely 111. It will be up to the practice to work out how it delivers that urgent care.
ST: There isn’t any registration in this contract. There hasn’t been any registration since 2006, so theoretically you only have regular patients, you don’t have any registered patients. So, if you had capacity, then that capacity can be filled by an ‘unscheduled’ patient. I don’t think you’ll be able to say, ‘I’m reserving this slot because one of my regulars might ring up with a problem’. You have to achieve 8.2% and at the end of the year if you’re struggling for those percentages, which you probably won’t be, you’re going to need to see all and sundry.
The intention of this contract is to increase access for those who currently can’t get access. That is evident in the fact that they’re bringing in these new care pathways to get the more complex patients treated as well.
NJ: The lack of notice for people to wrap their heads around what the business implications are of these changes feels wrong, if I’m honest. I also think that the core competency seems to be more about contract management and fine print nowadays, and that’s also a concern. There seems to be a great need for more clarity on this aspect of the changes. Let’s hope we get it. Thank you both.
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