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Is the UDA-only contract a port in the storm?

We look at why the UDA-only option might work better for some practices in the forthcoming financial year and examine the journey of leaving contract reform and reverting to the UDA-only contract.

Dan Cook
Dan Cook Vice Chair Welsh General Dental Practice Committee

Units of Dental Activity (UDAs) were suspended for two years during the pandemic but tracked in shadow statistics. With the pandemic conditions lifted, the current year 2022-23 contract volumetrics include an element of UDAs worth approximately a quarter of the contract value.

This is because the 2006 legislation still governs the practice of NHS dentistry until such time any new legislation is passed. However, the UDA shadow tracking within the new volumetrics continues.

Choices facing practices this financial year

Most practices (circa 80%) have opted for the reform volumetrics this year for a variety of reasons, not least because some aspects are familiar, such as fluoride varnish targets, but also emerging from the pandemic the targets seemed more obtainable than getting back on the UDA treadmill.

However, some 20% of practices felt that the new volumetrics were not going to serve patients well, especially those in high needs areas with a greater proportion of red patients, and so opted to revert to UDA-only contracts, without the necessity to complete full ACORNs which many dentists say are time-consuming and take time away from patient care.

After speaking to staff at my practice, I decided to return to UDA-only arrangements for the 2022-23 financial year. A decision based upon the high needs of local patients, many of whose oral health had suffered greatly during the pandemic. I was also very reluctant to sign up at short notice to a contract variation, including financial penalties, with only the promise of 'mid-year reviews' in mitigation – an instinct justified by recent events.

A difficult UDA year

I have been opposed to the UDA from the moment it was imposed upon us. That said, it is not true that anything is better than UDAs. I was an enthusiastic participant in the earlier contract reform stages where the needs of individual patients and the realistic capacities of high-need area practices were considered. There were some issues with the levels of bureaucracy and time taken to gather ACORN data, and there was much work to be done, but it did feel as though we were moving in the right direction back then.

This UDA year has been difficult, and we are expecting a degree of clawback due to staff family leave. However, we are unanimous within the practice that the UDA is the lesser of two evils for both patients and staff and I fear that we, and many of our patients, would have been in dire straits had we tried to meet the untested reform targets.

There must surely be a better way forward than this.

Future of NHS dentistry

The General Dental Service (GDS) reform volumetric targets for 2023-24 were explained in the Chief Dental Officer's (CDO) letter sent just before Christmas to all practices and Health Boards. For 2023-24, practices are entitled to work with the UDA-only option as the alternative to the reform volumetrics offer. As with the previous year, the UDA targets will be 95% of pre-covid.

Some practices are considering opting for the UDA-only contract in the forthcoming financial year for several reasons. Those practice owners believe this is fairer to historic patients who have been pushed to the back of the queue and are now suffering from poor oral health. Some associates have expressed a preference for UDAs because it is easier to understand the likely remuneration and to accurately check performance.

However, this can only be a temporary refuge from contract reform volumetrics as the CDO has indicated 2023-24 will be the last action learning year before the new contract is brought in through legislation. We are not convinced this time scale is achievable so it may be the case that the UDA-only contract could be available in 2024-25 as well, but only time will tell.

Looking ahead

Some practice owners may be considering using UDAs as a stepping stone to withdrawal from contracting with the NHS. We will report the findings of our first survey shortly and it will be interesting to understand the likely scale of reversion to UDAs and, more importantly, the longer-term intentions of practice owners to convert to private practice.

Our survey is open all week until Monday 20 February so please complete it soon.

Part of the legal process to devise a new GDS contract will be negotiation with us – your elected representatives. We have long called for the cessation of UDAs and that is the intended target of the government. However, UDAs must be replaced by target measures that work for practices and all dental professionals under the NHS contract.