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England: Ministers double down on NHS targets

Blog Author Shawn Charlwood

Blog Date 29/03/2021

​Government imposes harsher targets on NHS dental practices, but at least the door now appears open for real reform.



In a global pandemic NHS targets were always the wrong choice, at the wrong time. Dental practices in England now have a matter of days to prepare for a new target, which will take us through to the end of September.


Levels are now set to increase to 60% for the next six months for GDS contract holders, a level fewer than half of practices are currently managing to hit. For orthodontic practices the level will rise to 80%.


This remains an imposed policy. Whilst we’ve secured some concessions from NHS England, we have not agreed to an approach that only serves government accountants, not the interests of our members or the future of patient care.


Here’s what you need to know:


1 in 10 face the cliff edge

The term ‘decimation’ takes its name from the punishment the Roman’s dispensed to wayward soldiers, where 1 in 10 would face the chop, almost at random. And decimation is where we’re at.


We warned where this policy would lead, and now NHS England estimate close to 11% of practices are on track to fall below the 36% delivery cliff edge in the current quarter, and with the real threat of returning most of their NHS funding.


Clearly this policy risks having a lasting impact on access to services in communities across England.


“This policy risks having a lasting impact on access to services in communities across England.”

We remain clear that the cliff edge was unjustifiable, and at the very least NHS England has listened to us and pledged not increase the threshold in line with the new target level. So, whilst the overall threshold increases from 45% to 60%, the cliff edge at which an enhanced UDA rate is paid does not become proportionately more difficult to achieve.


For the 1 in 10 we will be working to ensure exceptional circumstances continue to be considered.


And we have pressed for clear and explicit instructions to local commissioners on flexible commissioning. It is no panacea for this unfit contractual framework, but at least it could enable some practices to spread their risk away from a punishing activity target whilst we strive for a more sustainable solution.


A way ahead on contract reform?

We’ve passed the tenth anniversary of the contract reform process kicking off, and UDAs are still with us.

The letter on targets does include a welcome statement from officials and the Minister indicating fresh commitment to see reform through, led by NHS England.


“We will play our full part working for meaningful transformation that benefits patients and dental teams.”

Again, this reflects the constant lobbying we have undertaken and is in no small thanks to so many members of the profession reaching out to their own MPs.


What’s outlined on system reform appears a mixture of potential ‘quick wins’ by October 2021 and wider ranging reform by April 2022.


It is unfortunate that what could be real progress should come packaged with punitive targets for the next six months, but we welcome this fresh commitment to change.


And we will play our full part working for meaningful transformation that benefits patients and dental teams.


The wrong kind of certainty

Key lessons from December have not been learned, with dental practices again left with days to adjust to new conditions.


Imposed targets are bad enough, but eleventh-hour announcements have again added insult to injury.


In the current period, colleagues have been forced to live from month to month, unable to plan ahead.


We have consistently pushed for a long-term plan. At least this target is set to run for two quarters, again an important concession to the arguments we have put on your behalf.


We are hearing distressing reports of the real human cost of what has been a short-sighted approach. Many dental practices are telling us that no staff have been able to take any time off, due to fear of not hitting their targets, and stress levels are rising whilst morale is falling ever lower.


Six months is not the kind of certainty any colleague would have asked for, but at the very least we will not be left in this position come the last weeks of June.


Practices still face an uphill struggle

There are no indications that standard operating procedures will be reviewed in this period.


The Chief Medical Officer has told Parliament he expects a COVID spike in late summer. There are certainly real questions as to how far we can expect a return to something like pre-March 2020 ways of working, as COVID moves from pandemic to endemic disease, with us in some form for the foreseeable future.


In the face of perverse activity measures, the focus has understandably shifted towards routine rather than care urgent care, just as we expected. The same logic has also impacted on orthodontic practices, where colleagues have felt compelled to focus on commencing new treatments rather than on ongoing care. A high activity target simply does not fit with what should be our current priority.


We remain clear these targets are at odds with the government’s official mantra, NHS standard operating procedure and even clinical advice that went to ministers.


“These targets are at odds with the government’s official mantra, NHS standard operating procedure and even clinical advice that went to ministers.”

Yet while colleagues in Wales and Northern Ireland are benefiting from our successful bids for investment in ventilation, there is still no movement in England.


Dentists in Wales have no targets. Colleagues in Scotland saw plans rightly shelved in the face of the new lockdown, and those in Northern Ireland now face levels at a quarter of those in England.


We know dentists and their teams continue to work unsustainably to try and meet the targets in what remains of the current quarter. Yet more than half of practices are currently unable to hit the 60% threshold.


Dentists remain in an invidious position, and we will continue to press for the support they need and deserve. We will of course be updating our model associate contract and FAQs to provide the answers members desperately need at this time.


Shawn Charlwood


Shawn Charlwood

Chair of the British Dental Association’s General Dental Practice Committee