It’s finally landed, and there’s no shortage of exaggeration and clichés coming from Ministers.
To be clear this 'Recovery Plan’ is unworthy of the title. We’d encourage anyone dissatisfied with the package to send a message to the Prime Minister.
But while it doesn’t even begin to save NHS dentistry, it will clearly have implications for dentists across England.
Parts of this plan will rollout from next month, but many vital details remain unclear and we are seeking urgent clarification on your behalf.
So we’ve pulled out the facts we have, and here’s what you need to know:
The New Patient Premium
For now, what we do know is that from March 2024 to March 2025 practices in England will receive a new patient payment. This will be set at £15 where the patient needs a band one course of treatment, and £50 where it is band two or three.
These payments will be converted into UDAs and claimable against your contractual UDA target, and so they are within, rather than on top of, your existing contract. This will be claimed on top of the normal UDAs for the associated band.
A new patient is one not seen by a practice in the previous two years, although the precise definition of a ‘new patient' has not been spelled out and we need urgent clarity on this.
A new minimum UDA value
From 1 April, contracts with a UDA value below £28 will have it uplifted to that new minimum.
We estimate around 700 of the 8000 odd NHS contracts will see some benefit.
We know – and Government modelling showed – there is a clear correlation between UDA levels and delivery. It’s not rocket science, but with surging costs this falls well short of where we needed the increase to be.
NHS England previously implemented the minimum UDA value by lowering the practice’s UDA target, keeping the contract value the same, with the result that the practice’s UDA value increases. If it does the same now, we would hope that, where this takes place, associates would see a proportional adjustment to their UDA targets so that the benefit of this uplift is shared.
Golden hellos
There will be 240 golden hellos available to dentists willing to work in areas where there are the worst recruitment issues.
That’s around 1% of the NHS headcount in England, so I’ll leave it to you to decide if that’s sufficient to meet the Government’s lofty ambitions.
These will be worth £20,000 and we understand that these will be paid over three years, with £10,000 in year one and £5,000 in the second and third years. Funds may be clawed back if the dentist does not continue to work on the NHS in the given area for three years.
But the areas where they will be offered have not yet been set out.
We can only guess what uptake will look like. Schemes for GPs have been well received and oversubscribed. However, a version of this scheme in Scotland (a much more generous offer of £25,000, over 2 years) is not attracting a high volume of applicants. With dentists willing to do NHS work in short supply, there is of course the potential for golden hellos to just move the recruitment problems from one area to another.
A real ringfence?
The plan commits to ‘ringfencing’ the dental budget. The problem is we’ve heard that before, and each time promises have been little more than rhetoric.
We have spoken to ICB finance directors who admit they have no choice but to base their future plans on raiding these underspends, given the eyewatering scale of their deficits.
Any new rules should mean that commissioners make all efforts to spend the money on dentistry. We hope that stronger assurances will be given for 2024/25 and we will continue to press NHS England for this.Given the modesty of the Government’s proposal underspends are not going anywhere.
So time will tell if this ringfence ever becomes more than an exercise in semantics.
The future of skillmix
There is no shortage of silver bullets in there.
And long held ideas about allowing dental hygienists and dental therapists to utilise certain medications without a written direction from a dentist will now be introduced.
The Plan does not state the full list of medicines involved, but it will include local anaesthetics and some antibiotics. And the timeline for allowing this has not been set.
The devil is in the lack of detail
Dental vans, early years prevention, provisional registration, dental student places…
There are so many other areas of the Plan where an intention is set out, but where the detail is even more scant than those I’ve already covered.
We have a commitment to using dental vans in areas without NHS practices. It has not been spelled out who will provide these vans, how they will be paid for, or even who will staff them.
The same is true for how the proposals on early years prevention, where little is said about who is involved in the teams to deliver this in nurseries, Family Hubs and schools and how it will be funded.
Local authorities – who are responsible for commissioning much of this care – are certainly puzzled, given there has been absolutely no engagement with them over what any of this will look like.
There is also a new proposal for ‘provisional registration’ for overseas dentists coming to work in the UK. This is something that will require careful consideration, legislative change and detailed consultation.
The Plan repeats earlier commitments to expand the number of dental school places from later this decade. What is missing is a commitment to fully fund these expanded numbers, covering the costs of everything from clinical placements and increased staffing numbers to expanding the dental school estate.
Where next?
While many aspects of how the Plan will be implemented remain opaque, we are seeking urgent clarification so that you have the certainty you need to treat your patients and run your practices.
We will provide further information once we have it, our members will be the first to know.
While facts are in short supply, claims have been made about this plan we simply do not recognise.
How will ‘millions’ of new appointments be generated, when there is nothing to boost capacity or bring dentists back to the NHS?
How is £200m in any way generous, when it’s less than half the levels of underspends seen last year, and expected again this year?
Where we get answers, we’ll share them. But we will not cease pushing for a better deal for our members and the patients they treat.