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Delays in NHS contract reform

As NHS England drag their heels on contract reform “quick wins”, we want to tell the Parliamentary Health Committee what you think about the NHS exodus.

Shawn Charlwood
Shawn Charlwood Chair, General Dental Practice Committee

When I last updated back in March on general dental practice contractual reform in England, I had hoped by now that there would be more significant news to share about how reform was developing.

Unfortunately, we’re a year into the contract reform process now and, against the backdrop of a gathering exodus from NHS dentistry, progress has been frustratingly slow.

No quick wins or substantive progress

Last year, NHS England said that if it is possible to make "rapid, modest and marginal changes to the existing national contractual arrangements" then "that should happen at the earliest opportunity". The stated intention was that these would be announced (if not implemented) by April 2022. That date has now been and gone, and we’re still waiting.

Long-term reform and getting rid of the UDA is our primary focus.

Whilst these reform discussions are confidential, I can tell you the issues we’ve been talking about with NHS England when it comes to short-term changes to the current contract. Unsurprisingly, these include: better rewarding complex and time-consuming dentistry; focusing on care for high needs patients; urgent care provision; skill mix and teamwork; and seeking to ensure that the funding allocated to dentistry is spent.

Our position in these discussions has been clear. Any modest and marginal changes to the current contract absolutely cannot be the end of the process. Long-term reform and getting rid of the UDA is our primary focus. It has therefore been particularly frustrating that we have taken so long to get through these initial discussions so that we can get into the detail of the important work on substantive reform.

Speaking out about the NHS exodus

Without real progress, I genuinely fear that we could see the death of NHS dentistry in England. Many are already moving away from NHS care, with widespread reports of colleagues either reducing their NHS activity or handing back contracts entirely.

Around 3,000 dentists in England have left the NHS since the start of the pandemic, and both private and NHS providers continue to report severe workforce problems. A shift to a 95% threshold from April and the signal that it will be full targets from July, is not the supportive messaging the profession and our patients need right now. Drastic action is needed to stem the flow.

Your feedback is key to the recommendations the Committee itself will make to government.

With the exodus from NHS dentistry accelerating, I have been called to give evidence direct to Parliament's Health and Social Care Committee as part of their ongoing inquiry into recruitment, training and retention across health and social care. To ensure the Committee, chaired by former Health Secretary Jeremy Hunt MP, has sight of the very latest intelligence, we asked for your feedback in a survey.

Thank you for taking the time to share your views. Your feedback is not only key to the evidence I will offer, but also the recommendations the Committee itself will make to government.

Levelling up dentistry?

Curiously in the wake of the latest stories of access difficulties, a new standard line has emerged from Whitehall. Whether its access problems or General Anaesthetic backlogs, the stock response is now “we are committed to levelling up dental health across the country.”

We are under no illusions. It will take more than slogans to save this service, and modest and marginal change won’t cut it either. Progress will hinge a decisive break from the UDA, backed up by sustainable funding.

But as the government has chosen to adopt this language, we are more than willing to measure their proposals and ambitions against that standard. We will continue to emphasise the need for real urgency and real change and will seek every opportunity to ensure dentistry retains its public and political profile.

Keeping you updated

I appreciate that the lack of information through this reform process can be frustrating. There has sadly been very little to report.

We know how much frustration and anger short-term notifications of contractual change have caused across the pandemic. So we will seek to make sure that there is as much notice as possible of any changes that do happen, however modest and marginal.

You also have my word that we will seek your views if, as we hope, we get somewhere across the next year developing proposals that replace the current contract, and finally secure a better system that gets rid of the UDA.