What is the issue?
The current dental contract implemented in England in 2006 which remunerates dentists purely on activity, is not fit for purpose. It has received criticism from dentists, two governments, a Health Select Committee and the Chief Dental Officers for England and Wales.
We feel that working to activity targets is like 'being on a treadmill' and wrongly puts the focus on meeting these targets, rather than on patient care.
There is strong evidence that working under the contract is associated with stress and burnout among dentists.
The Steele Report (June 2009) affirmed that the profession's goal was to improve oral health and emphasised the need for better health outcomes through prevention.
Given the general fall in levels of dental decay over the last fifty years, the report concluded that it did not make sense to have a contract that remunerates activity only.
We lobbied forcefully to ensure that dentists concerns were heard and we called on Government to reform the 2006 system.
Dental contract reform prototypes
Elements of a reformed contract were piloted in 2011 in England and the findings were published in 2014.
The pilots were based on capitation and quality, with care being provided through a preventive care pathway. The approach was popular with patients and dentists, but resulted in a decrease in access for patients in most of the pilot schemes.
In 2015 the Department of Health introduced the prototype remuneration model. A small number of dental practices have, since 2015, been testing versions of a possible new system.
The Government currently has two blends of a single reformed contract on the table, both including activity targets.
There are 76 practices currently taking part in the Dental Prototype Agreement Scheme. They are testing new ways of providing NHS dental care with an increased emphasis on preventing future dental disease.
The Department of Health and Social Care has published an evaluation of the first year of the prototypes.
They have announced plans for include another 50 more prototype practices in England from October 2018 and there is a possibility that new dental contract arrangements may start to be rolled out from 2020.
Dental contract reform in Wales
In Wales, the Welsh Dental Pilot programme was developed to test alternative approaches to the delivery of NHS dental services in Wales and ran from 2011-2015.
It aimed to focus on widening access; improving quality; and incentivising prevention. Two of the eight pilots moved on to a trial of a more advanced 'prototype' of this new contract in 2016, based on 85 per cent capitation/15 per cent quality.
At the end of the pilot programme the majority of the pilot practices reverted back to the existing contract and most report that this has been detrimental to teams and patients.
The two 'prototype' practices remain on the new contract and will not return to using UDAs.
From January 2018, 23 dental practices in Wales are testing a new pilot scheme, which includes giving 10 per cent of UDAs over to oral health needs assessment data collection.
What do we want?
We believe patients deserve better than a watered-down version of the current contract: activity targets (UDAs) are bad for both patients and dentists.
We continue to push for a contract that puts prevention first. If activity targets are necessary, then they must be related to prevention and treatment that is necessary.
We are concerned about the implementation of any revised contract and we want assurances that practices can retain viable business models, and that patient access will not be compromised.
We will continue to press the Department of Health, NHS England and its local commissioners to drive forward meaningful contract reform and to fully support those participant practices.
Read more about our work on dental contract reform in our blogs.
If you have any questions on NHS dental contract reform please get in touch with our policy team.
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