When I was elected GDPC Chair earlier this year, my first action was to reach out and listen to what you want to see from reform. We conducted a major survey to gather views on the sort of NHS dental service we would actually want to work in.
That consultation found a strong consensus on a wide range of points. Many of the ideas we put to you had greater than 95% agreement. It is extremely positive to see the profession speaking with a shared view and a single voice.
Agreement on the fundamentals
We’ve received strong support for a contract focused on prevention.
English GDPs want a contract that is practical, financially viable and simple; where payments reflect the costs of treatments; and patients know what is and isn’t available on the NHS. You told us that it was important that the NHS set a clear purpose for what dentistry is trying to achieve.
I’m incredibly grateful for this feedback. It will allow me and my negotiating team to go into our meetings with government with a clear understanding of what you want to see from a reformed contract.
The challenge for us now is to ensure that we open the door to the negotiating room and start those talks without any further delay.
Earlier this month, Stephen Kinnock MP became the first Dental Minister in decades to address a Local Dental Committee Conference. In itself, that sends a message, but it was also reassuring that his diagnosis of the state of NHS dentistry matched the reality we see in our practices. He acknowledged that the current situation is ‘Dickensian’ and the current contract is somewhere between a ‘treadmill’ and a ‘straitjacket’.
Speaking to LDC reps about contract reform, the Minister said, “While there is no one perfect payment system, we must build on experience, and we must address the contract in this parliament”. I agree with him on all three points.
"The challenge for us now is to ensure that we open the door to the negotiating room and start those talks without any further delay."
A blended contract
After nearly 20 years with the Units of Dental Activity (UDA) contract, I think all of us are crystal clear on what an imperfect payment system looks like. Contract reform must deliver a fundamental break with the UDA.
There is, of course, no single perfect alternative.
In developing our thinking and proposals for reform, we’ve focused on what will deliver a prevention-focused system, which works for different patients and different treatment types, and makes the NHS an attractive place to work.
That’s why the GDPC’s proposal to government has been for a contract that blends different types of payments so that the right funding and incentives are attached to the right types of patient care.
We think that weighted capitation is the best way to pay for routine care. We know that patients value a long-term relationship with their dentist, and that this is likely to help improve patients’ oral health. It also structures payments and care in a way that focuses on preventing oral disease, rather than just treating it once it develops.
Alongside this preventative routine care, there are still many patients who have high treatment needs. The UDA contract has failed them, and it is critical that a new system ensures they are cared for properly. We’ve proposed that there should be an activity payment for this treatment, probably based around an item of service model.
Then, there is urgent care, which comes with its own unique challenges. The time needed for each patient is unpredictable, as is demand for the slots and patients’ attendance. Sessional payments have been demonstrated to address these challenges and work successfully in Integrated Care Board commissioned schemes. This should be made the national model for urgent care.
There was a clear message from your survey responses that a reformed contract needs to be kept simple and practical. We will need to balance the desire for simplicity with ensuring that payments are a good fit for the clinical activity.
"A long-term relationship, focused on prevention, delivered results for improving individual patients’ oral health."
Learning from the prototypes
The Minister also said that we should learn from experience. He is absolutely right.
I worked at one of the around 100 practices that prototyped a different payment system based largely around capitation. At its heart was a clinical pathway that did dentistry the way we were taught at dental school. The model had many things going for it that could and should be brought over to a reformed contract. For me, the key thing was that a long-term relationship, focused on prevention, delivered results for improving individual patients’ oral health.
There are also things we can improve based on the learnings from that model. In the prototypes, the capitation payments weren’t weighted to reflect patients’ needs, meaning that those in high needs areas found it harder. There is a simple solution to this by applying weighting based on oral health need. The prototypes also used UDAs for some treatment, meaning patients with high needs continued to be under-funded. Again, the learning is clear: scrap the UDA.
Urgent progress
Now, we need to get down to the work of negotiating that contract. We are ready to start now, and the ball is firmly in the Government’s court.
We have made it clear to government that they have essentially run out of time. Dentists are already walking away from the NHS, reducing the number of UDAs they do, or packing it in altogether.
85% of survey respondents said that if we don’t see reform by the next election, they don’t think NHS dentistry will remain a viable service.
In the coming weeks, I expect NHS England will bring forward changes to the UDA contract. We have discussed these proposals and fought for the very best outcome for dentists and patients. These changes will, I hope, deal with some of the worst aspects of the current system, but I am very clear that this is not a substitute for real reform. The UDA is not fit for purpose and must be scrapped altogether.