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Concerns about orthodontic procurement: what you need to know

We have serious concerns about the NHS orthodontic procurement exercise that was launched this February. This procurement exercise is for orthodontic agreements in the whole of Southern England, which are due to expire on 31 March 2019.

The draft tender documents have been available for comment and we have submitted detailed comments setting out our concerns. NHS England has now made some concessions, notably on price.

We met with NHS England during 2016 and 2017 to discuss a range of issues, including close-down arrangements and we reached an agreement on this particular aspect of national NHS England policy. 


Our concerns about the new tendering process

Our concerns about the tendering process centre around:


  • The price banding for which tenders will have to be submitted is at £54.89 to £58.89 - compared to current average value of £64. In the first two years, 100 per cent of contract value is not paid to any new bidders even though target UOAs must still be delivered. Following discussion with NHS England in February the lowest level of UOAs allowed in the tender has been raised from £51.89 to £54.89 - but we still do not feel it recognises the true cost of orthodontic care;
  • bidders deemed to be at high financial risk will be excluded from the process but given the relatively low UOA values on offer, practices will be at greater financial risk because expenses may not be covered
  • the practice must have a least one dentist on the GDC specialist register which will exclude many current providers. Care and treatment must be personally supervised by the specialist;
  • in the draft tender information, providers taking on patients previously treated by another provider would have received no UOA credit. The BDA together with the BOS managed to soften this provision slightly;
  • Lot sizes are large and may favour larger providers;
  • The BDA has been told by NHS England that the model of providing care is now based on orthodontic therapists. We do not believe this is true across the country and there are not enough therapists to work in every practice.  If services are specialist led then non specialist dentists may well not have a role except as a practitioner fulfilling an orthodontic therapist's role;

The public consultation was flawed, in that it did not disclose plans to patients, and feedback from 1600 respondents has not yet been shared.

NHS England has undertaken a public consultation, but we have concerns about how this has been conducted, and we await the results of the patient survey with interest.


The legal challenge

We implemented a legal challenge against NHS England's use of a ''Dynamic Purchasing System' (DPS) in its tendering of £1/2 billion of orthodontic services, initially across the South of England, but our legal challenge has been suspended whilst NHS England undertakes preparatory work for the procurement of orthodontic services.


In the interim, NHS England has announced that existing providers, whose orthodontic contracts were due to expire next spring, will have their contracts extended until March 2019.

​What should I do?

Our advice is that providers should think very carefully about whether it is in their business, or personal interests, to take part in the procurement, and take advice from their accountant.


BDA members can access our range of advice on tendering, incuding our hints and tips, if you are considering apply for the tender.

If you are unsure of what to do, BDA members can contact our advisers who can offer support.