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​4th wave prototypes: Failure to change contract model a wasted opportunity

15 February 2018


The British Dental Association (BDA) has responded to news that the Department of Health and Social Care and NHS England have opened calls for interest in the fourth wave of NHS contract reform prototypes in England.

The BDA has restated its commitment to the reform process, but expressed frustration over the pace of change, and the failure to offer changes in the prototype model for this latest wave. Despite widespread support for the approach to clinical pathways, dentist leaders have expressed concern that many practices have struggled to deliver under the prototype business model. The BDA remains committed to a model that maximises capitation.


The deadline for applications is Friday 9 March 2018 at 9am.


The BDA's Chair of General Dental Practice, Henrik Overgaard-Nielsen, said:


"The BDA and GDPC remain committed to the need to press ahead with reform of the existing contract, although the profession is increasingly frustrated and concerned by the slow pace of change. We also believe that the absence of any change in the prototype model for the fourth wave is a wasted opportunity.


"The clinical pathway being tested across the programme has been widely welcomed and supported by both patients and clinicians. However, the prototype business model has not operated consistently with the same degree of success. Some practices, including those coming direct from the UDA system in the third wave, have struggled to achieve contractual targets without additional investment and, like GDS practices, face clawback.


"The profession continues to owe an enormous debt of gratitude to those practices which have taken part so far in the pilot and prototype process, and those considering participation in the fourth wave.


"We need to continue to test the prototype system, but practices considering involvement in the fourth wave will clearly need to reflect on the potential business impact. Practices will want to look at their prospective patient number and activity targets, and also consider which prototype blend would best suit them. There should be an open dialogue about whether blend A or blend B is better for the practice. We remain of the view that a higher capitation payment element is the best way forward." 


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