Our letter gives an honest appraisal of the Government's recently published end-of-year reconciliation guidance for General Dental Service (GDS) contract reform practices and includes commentary on the forthcoming volumetrics for 2023-24. And with the crisis in dentistry once again leading the news we also reflect on the progress and future of contract reform and specifically levels of engagement with the profession.
We are troubled and disappointed that clear recommendations, direct from the profession, have been largely ignored in the final version of the guidance that has been published this week. We have been working swiftly to provide a detailed review of the draft end-of-year reconciliation guidance ahead of its publication.
Unrealistic targets
We are deeply concerned that anticipated tight adherence to the rules by several Local Health Boards (LHBs) could result in significant levels of clawback for many of the practices who didn't reach their targets, even with the 5% tolerance. This could result in GDS contracts being handed back in droves or reduced to the tune of the clawback value. Dentists simply cannot work inside the current broken NHS system.
In two surveys last year many of us expressed concerns over future clawback and likely inability to meet the targets set out by the Government. The reconciliation process is going to be even more challenging for LHB contract managers this year, with a complex formula to follow and data sets to analyse. It is increasingly likely that this will proceed into the summer months which will leave affected practices in a state of financial limbo.
We acknowledge all the engagement work undertaken by the Chief Dental Officer (CDO) over the last six months, presenting cause for hope that positive changes were on the horizon. Unfortunately, it has become increasingly apparent that the rate of change and the improvements needed are slow or not in evidence at all. I have laid out all these growing concerns in several meetings with the CDO.
Faulty contract reform process
The volumetrics for 2023-24 published by the Government before Christmas do give a useful notice period for practices to weigh up options for the next financial year. The volumetrics are still experimental and the changes to new patient targets may be an improvement at the margins with urgent patient numbers being better recognised and practices rewarded for ethical dentistry.
It is still evident, however, that long-standing patients are being held back in favour of seeing new patients to hit targets. This continues to cause us concern, not least because of the unspoken amassing of oral health problems in patients being pushed down waiting lists who have been waiting for years to be seen.
The ring-fencing of appointments for new patients is being continuously touted by the Health Minister as provision of over 100,000 new or extra NHS appointments. This is patently not the case. These are simply appointments taken away from historic patients to service new patients and hit targets. This level of misrepresentation to the public does not instil confidence in the contract reform process.
Looking ahead
We will continue to work assiduously to support the contract reform process. It is counterproductive that the ethos of togetherness and espoused by Government is not playing out. We continue to make repeated requests for the data on which contract reform measures are predicated with no response and our advice about the real-world impacts of the shifting sands of contract reform continue to fall on stony ground.
"There may be frustrations from some dentists who may not like the new system" claims Health Minister Eluned Morgan. "But it's very, very much a minority."
The reality is dental practitioners across the country are experiencing a rapid decline in mental health due to the mounting stresses in NHS dentistry. Yet the Government are no closer to fixing the underlining issues. We are calling for a workforce strategy and workplan to stem the haemorrhage of associates and dental care professionals from NHS dentistry which are rebuffed by the unremitting response of skills-mix.
My committee will be holding an extra-ordinary meeting shortly to consider the current state of play with contract reform and the possible ways to engage with the process in the future. We have been consulting with Local Dental Committee representatives who have unanimously backed the BDA's letter with an open letter of their own to the CDO. We will continue to seek your views on how we move ahead.
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