In my last blog, I explained the GDS reform offer for 2022-23 made by the Welsh Government. At the time we only had a week to provide feedback on the terms, having been presented with a fully formed draft. We pulled out all the stops to make this unreasonable timeframe work, by giving ongoing feedback to the Welsh Government dental branch on your behalf.
However, further improvements and clarifications about the offer still need to be made.
Over 250 dentists responded to our rapid survey, revealing that details of the offer remain unclear to many dentists. Many did not find the Welsh Government's recent engagement evening enlightening and many of your questions remain unanswered. The lack of a pilot is also a big concern for some and some feel that reform was being pushed through.
Survey reveals widespread concern about offer
You told us that you have considerable misgivings about how this reform offer will work. More than 80% of practice owners were concerned about waiting times for existing patients. Similarly, 80% of associates were concerned that the offer would have a negative impact on delivery of care. Over 90% of practice owners thought the new patient target was too high, and 57% thought the historic patient target was too high.
Over 90% of practice owners were concerned about the likelihood of clawback.
Moreover, over 90% of practice owners were concerned about the likelihood of clawback against one or more of the metrics. Over half of the respondents were concerned about accurate data capture and data transfer which is an added concern with future contract reconciliation.
The Local Health Boards are now providing more details, writing to practices individually with the calculated targets according to the contract values. Some practices might not receive these details until next week. Things are still unclear and LHB's are seeking further guidance from the Welsh Government, particularly around how much discretion they can apply to the various targets.
Weighing up the options against the risks
Some of your misgivings about the reform offer may be exacerbated by the cloudiness of calculations for patient numbers and how the figures will play out in your practice. Two thirds of practice owners felt able to weigh up the risks and benefits of the offer, but perhaps the numbers don't stack up for you, and the risks are looking too great for your business. The lack of acknowledgement of patient needs and the demands on practices in high need areas has been frequently commented on, and there is frustration about the lack of RAG weighting of target numbers.
44% indicated they intended to revert to the UDA-only contract.
Nearly two thirds of practice owners told us they are not intending to take up the reform offer and 44% indicated they intended to revert to the UDA-only contract. However, 82% of other dentists, including associates, felt that neither offer was acceptable. This has clear ramifications for the NHS workforce.
How will the UDA-only default contract work?
It remains unclear how the UDA-only default contract will work. We have raised with the Deputy Chief Dental Officer (DCDO) several times that the software for the ACORN from April means that only a full assessment with 20+ data points would fulfil the software requirements for the FP17W form. Otherwise, it will be rejected.
In other words, an ACORN-lite version envisioned for the UDA-only contract would not be software compatible. However, the FP17W without the ACORN requires just four data points that relate to delivering better oral health, ie diet, alcohol, smoking, and teeth cleaning with fluoride toothpaste, which would seem reasonable for the UDA-only contract. We are awaiting a definitive answer on this from the DCDO.
Looking to the future
It is clear from your responses that NHS dentistry is looking less attractive to the dental team. Nearly two thirds of practice owners are considering a reduction to their NHS commitment in the next three years and one quarter are planning to go fully private. Similarly, one third of associates and other dentists are considering alternative options within dentistry.
Practice owners are contacting our Advice Team as they consider their options.
Practice owners are contacting our Advice Team as they consider their options. Over three quarters of practice owners didn't know how to determine associates' payments. For our Expert members, the associate agreement template should be able to support this process. The UDA-only template still needs clarification about the ACORN requirement. Others are reviewing our advice on moving to private practice to assess their options.
We will keep you updated with new developments and intend to run an open evening event soon. We hope this will be an opportunity for reflection and to gain further insights, which we hope to share with the new CDO when they start in post next month.
Extra and Expert members can contact our advisors for one-to-one advice by calling 020 7935 0875 or emailing [email protected].