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England: Seeking NHS contract provisions that are fit for purpose

3 September 2020


The BDA is currently in discussions with NHS England regarding what the NHS contract should look like for the rest of this financial year. As our discussions continue over the coming weeks, we will be seeking a balanced approach that recognises ongoing constraints and increased cost pressures on practices. It must also be flexible as the pandemic's progression is unlikely to be predictable or consistent across England. 


Currently, dentists working in general practice in England continue to operate under current NHS contractual arrangements - which have included assessment of activity since 20 July.


Courses of treatment and patient triage are being counted and at least 20% of previous course of treatment volumes are expected. Practices are also expected to maintain the same NHS to private proportions as occurred pre-lockdown.


During this time, many of the existing contractual provisions rules continue to apply. Patients requiring an urgent appointment should be offered the next available slot, whether or not they have been treated on the NHS previously at the practice. Contractors have been advised by the NHS to prioritise patients with urgent care needs.


NHS England advice is that the sequencing and scheduling of patients should take into account the urgency of needs; the particular unmet needs of vulnerable groups and practices' available capacity to undertake activity.


Whilst there are some specific requirements on practices, this current framework relies on trust.


We need the profession to do the right thing during this period in providing high quality patient care in the spirit as well as the precise wording of these current arrangements. If that does not happen, it will inevitably influence the framework for the second half of this year and potentially beyond. 


If colleagues act outside of the spirit of the interim contractual framework agreed, their actions are likely to jeopardise our position as a profession. In particular, the 20% volume of care requirement to receive full contractual payment is not a minimum, it is a threshold. Practices must continue to spend the same amount of time seeing NHS patients as prior to the pandemic. Priority should not be given to private patients where NHS capacity still exists.


NHS England's July letter of preparedness indicated that it expected all practices to be providing face-to-face interventions, delivering as comprehensive a service as possible (whilst recognising that capacity may still be constrained). There is nothing to stop practices doing routine assessments, but there is an expectation that priority must be given to patients in pain, irrespective of whether they are new patients or not to a practice. 


As a profession, we have risen to the demands made by this dreadful pandemic. If we get the current period right, it sets the tone for what can be agreed for the rest of this year and beyond. We might even see some good come out of this in the shape of longer-term NHS contractual provisions that are finally fit for purpose. If we get it wrong, we are much more likely to see a return to low trust, high scrutiny contractual arrangements.