England: Dental system reform
The current dental contract is based purely on activity and is not fit for purpose. We're calling for much-needed reforms. However, the system reform process is protracted and complex.
Here is where we currently stand:
- The prototypes will come to an end on 31 March 2022
- We are in discussions with NHS England on 'quick wins' to be implemented in the coming months, as well as long-term reform
- Our priority is to pursue long-term reform that gets rid of the UDA
- We are in favour of a capitation-based contract as the basis for long-term reform
- Changes are expected in April 2022 and we will keep you updated.
Worrying reversals: Prototypes abandoned
The first phase of the contract reform process began in 2011, with pilots and prototypes testing a capitation-based payment system and a clinical pathway. This will conclude in March 2022, with prototype contracts reverting to the standard contract.
It is profoundly disappointing that the prototype approach was abandoned in this way. There is significant learning that can be taken from their experiences of this different way of working, as well as a substantial amount of analysis and modelling done behind the scenes, that could be used to develop a reformed contract.
We have called on NHS England to ensure that there was a fair and reasonable transition for prototypes to return to the 2006 contract. Instead, the support that is being offered is limited and far from what prototypes will need. We will continue to advocate for these practices, who stepped up to help the profession by testing a new way of working and should not be financially disadvantaged as a result.
The most recent phase of contract reform began with an advisory group in the summer of 2021. It has looked at the strengths and weaknesses of the current, and alternative, contracting approaches and to begin to develop proposals which will secure NHS dental services which are fit for the future.
Since then, we have had a series of scoping meetings with NHS England. To give the process the best chance of succeeding, these meetings are being held on a confidential basis to allow for open and candid discussions. However, we can confirm that:
- The discussions have been divided into two distinct sections: quick wins, defined as "rapid, modest and marginal changes to existing national contractual arrangements" and long-term reform
- Much of the immediate focus has been on achieving quick wins with the stated intention of announcing some of that from April 2022
- The areas discussed include: focusing on care for high needs patients; urgent care provision; fairness in terms of what activity the contract rewards; skill mix and teamwork; rewarding prevention; and making the profession feel valued and genuinely part of the NHS.
We will seek to ensure that there is as much notice as possible of any changes that do happen in the coming months, however modest and marginal, as we know how much frustration and anger short-term notifications of contractual change have caused across the pandemic.
Whatever changes are possible from April this year, they cannot be the end of the process. Our focus is on the need for longer-term reform, and specifically getting rid of the UDA.
Our General Dental Practice Committee has had a long-standing and clear position in favour of a capitation-based contract, in which dentists are properly supported to deliver prevention-focused care to their cohort of patients. We will continue to make a clear and strong case on your behalf.
Community Dental Services
A process for Community Dental Services system reform began in late 2021. There had previously been three CDS pilots, which, like their GDS equivalents, are being discontinued from the end of March 2022. NHS England has held some initial scoping meetings, but to date there has been little progress made.
If you have any questions on NHS dental contract reform, please get in touch with our policy team.
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