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Dental contract reform: our asks for 2020

Blog Author Penny Whitehead

Blog Date 12/12/2019

 

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Photo credit: Getty Images

 

During 2019, we have continued to push for a reformed NHS dental contract that works for both patients and the profession.

As you might be aware, prototype practices in England have been testing a new clinical pathway and remuneration model for the last few years.

The contract payments are based on a combination of capitation, continuing care payments for maintaining a patient list, and activity payments.

These 102 prototype practices are currently testing two different 'blends' of contracting, each using a different proportion of activity and capitation:

Blend A


Payments in Blend A are made up of roughly 60% capitation and 40% activity.

Activity is paid for Band 2 and 3, and capitation payments cover all activity that would have been done under Band 1.

Blend B

Payments in Blend B are made up of roughly 85% capitation and 15% activity.

Activity is paid for Band 3, and capitation payment covering all activity that would have been done under Band 1 and 2.


What is the BDA doing to influence NHS dental contract reform? 

The General Dental Practice Committee (GDPC) has been working hard to influence the contract reform process and to secure improvements to the prototype model, so that it works for dentists.

We've been negotiating on a number of issues and the Department's National Steering Group has made some recommendations for the final roll-out:


1. Three-year capitation period

A practice will be paid capitation for a patient for three years after the patient's last non-urgent course of treatment unless the patient moves to another NHS practice. Every time the patient returns for a non-urgent course of treatment the clock resets for another three years.


2. Weighted capitation

Capitation payments per patient will be weighted depending on patient needs. The proxy for patient needs will be the patient's age, sex (for adults) and deprivation; with deprivation based on the patient's postcode.

If weighting is at the right level, this should help to incentivise practices to take on high-needs patients.


3. Different options at roll-out 

The programme, if approved by Ministers and NHS England, is still aiming to start the roll-out in April 2021 on a voluntary basis, possibly with two options, either Blend A or B.

The GDPC takes the view that we want to see only Blend B rolled out (see below), and we have asked for dental practices to be given flexibility on when they move over to a reformed system


4. National tariff for capitation and activity values

The GDPC has called strongly for there not to be a transfer of the inequities of UDAs into a reformed dental contract. We agreed to recommend a national tariff for capitation and activity values.

Contract values will stay the same, so this means that some practices will have to see fewer patients, and some, more patients, and will have to do fewer, or more, UDAs.

The activity targets should be reduced by 20-30 per cent in the reformed contract to take account of the reformed contract being prevention-based.   


What do we want for dentists?

We've called for a number of further changes, that we believe need to be made for the reformed dental contract to be fit for roll-out:


1. Item of service

UDAs are hugely discredited, and we've made the case for them to go.

We want them replaced by an item of service tariff, especially since we believe this will incentivise taking on high-needs patients.

The Department of Health and Social Care (DHSC) states that it is not possible for it to conduct the necessary analysis for this ahead of a 2021 roll-out, and therefore want to delay any change to the activity measure until after the initial roll-out.

We are concerned that a non-capitated activity (NCA) measure is still going to be part of the financial arrangements and we will continue to strongly make the case for the need for capitation, to ensure prevention (see below). 


2. The case for capitation

Dentists want to do the job of dentistry. We are conscientious and caring healthcare professionals and if we could just get on and treat our patients (and be fairly remunerated for it), then our patients would get the care they need.


We believe that dental reference officers should be employed, to ensure that the rules are being followed and patient care is being delivered to the highest standard possible.

If we really want to incentivise prevention, we believe the best way is to give dentists flexibility, is by allowing for capitation, and let us get on and do our job. The current system makes no-sense when we are technically incentivised to do fillings and crowns. 

'Incentives' to just drill and fill is what we have been arguing against for many years. 

 

3. Blend-B only

If we cannot have flexibility on capitation, then we only want blend B to be taken forward as this has the highest level of capitation and we believe is the most appropriate to deliver on prevention.

If DHSC insists on having Blend A as well then, the choice of A or B must be for the practice, not for commissioners – we believe it's the dental practitioners working on the front line who are best placed to make this decision, based on their patient cohort.


4. Financial stability and viability of dental practices

We have strong concerns about practices being left in 'financial limbo', if and when they transfer to the reformed dental contract. We believe there needs to be a phased roll-out of any new contract, with practices given a choice on when they switch.

We have been arguing for a long run-in time, as well as guarantees and support to ensure practices continue to be financially viable and there is stability.


5. Reduction in capitation targets

A substantial number of prototypes are having difficulties in hitting their capitation targets.

The Government must acknowledge that prevention takes more time, and we, therefore, need a reduction in the capitation targets.

The amount of money paid per patient has gone down by almost 15% in the last five years, we simply need the Government to re-instate the amounts paid five years ago.

 


Getting the best deal for our patients

It feels like we are closer from getting what we need to give our patients what we know is possible but issues still remain.

We will continue to fight on your behalf, to ask the Government to see reason and acknowledge that dentistry needs to be taken seriously, be appropriately-funded and to let dentists get on, and do what they do best.

 

Penny Whitehead, Head of Policy and Research

 

 

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