Tom Bysouth on the Welsh Government’s proposed recovery plan for NHS contracts.
There has been a lot of anxiety across dentistry in Wales over what the Government’s suggested variation to individual NHS contracts will mean in practice. Last week we met with the Chief Dental Officer (CDO) to clarify their proposals and to provide you with some much needed answers.
What is the offer from the Welsh Government?
After the Welsh Government's publications in late May, it looked like the world of NHS dental contracts in Wales had changed forever. However, our discussions have since helped to reframe the proposals into a recovery plan up until March 2021.
From 1 July 2020, practices will receive 90% of their contract value. This will then move up to 100%, potentially from September. It is our view that the sooner this is moved to 100%, the more secure practice viability can become.
In return for this 90% of contract value, practices will work within the scope of the de-escalation plans, at present in the amber phase, and work through the back-log of patients as best as possible on a prioritisation of needs basis.
Practices can be in heightened amber and only offering non-AGPs, or be in low amber and be offering AGPs as well, as long as they are set up and signed off by the relevant authority.
Key to this offer of 90% is the move away from the UDA, and its replacement with the UDAS, (units of dental assessment), an oral health assessment-based model. This new model may stay after March 2021, and we all can shape it.
We support the protection of the contract value and the move away from the activity treadmill and we welcome confirmation that there will be no patient number target up until March 2021. However, we appreciate that many questions remain and can only be answered with time.
What is the UDAS?
“The Unit of Dental Assessment (UDAS) is a move from payment based on activity, toward payment based on patient need and number.”
The Unit of Dental Assessment (UDAS) is a move from payment based on activity, toward payment based on patient need and number.
I believe that this is an improvement. Payment based on activity targets - at a time when activity is necessarily reduced - does not work.
However, I know that many details are to be sorted out, and in the long run it is those details that will be so vital. The recent publication of the ACORN guidance is one piece of the jigsaw.
For now, the Welsh Government proposes to protect the overall contract value (subject to previously announced abatements) up until March 2021 to try to secure practice stability.
What is the ACORN?
Assessment of Clinical Oral Risks and Needs (ACORN) is a
risk assessment form and includes the things we should all be recording in any good examination. There are two versions, one for routine care and another slimmed-down version for emergency patients.
Colleagues have rightly raised concerns about some data being recorded on the urgent form. We don’t think that every urgent patient should be offered a routine assessment. The requirement is to complete the necessary data points on the FP17W. This must depend on the practice’s capacity and ability to take on new patients. The door cannot always be open.
The data points are essential. They are sent off on the FP17W to the NHS Business Services Authority which will collect this patient risk and need data. I recommend having a good audit trail of ACORN forms.
The ACORN forms will change occasionally, so please expect things to alter with time. We have raised this issue with the Welsh Government and asked for clarity for you.
Is ACORN the new target? Do I need to see all my patients by March 2021?
No and no. There is no patient number target up to March 2021 because of the challenges with social distancing and thus throughput. We have stood very firm on this in discussion with the Welsh Government.
There are a range of key performance indicators (KPIs) in development that might be applied after March 2021. These include patient numbers, oral health need and risk, and fluoride varnish applications. Health Boards and the Welsh Government will want to measure something, and these discussions are ongoing.
This new contract is being forced on us. Can I stay with the UDA model?
Firstly, it is not a new contract as that needs legislation changes. The move to the UDAS model involves flexing the current regulations as much as possible.
Yes, you can stay with the UDA model if you wish, letting your Health Board know would be a good place to start. You will know better than anyone else what is best for your individual practice. In making any choice, I encourage you to consider social distancing, provision of AGPs and patients throughput.
UDA numbers will still be ghosted in the background, so practices will be able to see a comparison.
If I stay with the UDA might there be clawback?
There could be. Your UDA target would be 75% of the original. The UDA target did not count for April, May and June. When deciding whether to stay with the UDA model you should factor in how much activity you can complete going forward, and whether it will allow you to meet your UDA target.
Will the UDAS definitely be better?
“We want what is best for dental teams in Wales.”
We all hope so. We want what is best for dental teams in Wales, we know you are all different and one size cannot please all. We know the issues with the UDA system, and have long called for its abolition. But I acknowledge that this new system is going to be a leap of faith.
How about orthodontics?
Orthodontic contracts will also move away from the UOA model and work on a patient need basis. We are waiting on the Welsh Government to release their advice on this.
Going forward we plan to meet again with the CDO for further discussion and I will keep you informed of progress.
Chair of the Welsh General Dental Practice Committee