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Update on NHS system reform

​NHS system reform is a complicated process. We have been pressing for change to the NHS contract in England for more than 15 years, so it was welcome news when the Government committed to meaningful reform last year.

Shawn Charlwood
Shawn Charlwood Chair of the BDA’s General Dental Practice Committee

Our reform discussions are by their nature confidential, but here I'd like to give you as much insight as possible into the process so far and outline how I think our messages are getting through.

First steps

The most recent phase of NHS system reform started at the end of March 2021, when the former Health Minister, Jo Churchill, made a joint commitment alongside NHS England to work towards reform.

When the process was launched, 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." A parallel process is underway for community dentistry in England.

The first step was NHS England setting up an advisory group during the middle of last year, to look at the strengths and weaknesses of the current, and alternative, contracting approaches and to begin to develop proposals which will secure NHS dental services which are fit for the future. We were involved in that group alongside other stakeholders across dentistry.

The work of the advisory group finished in the autumn and we then moved into a series of more detailed discussions on potential proposals, described as 'scoping meetings'. These are not formal negotiating meetings but are covering the ground most people would expect from a negotiating process, and have informed the development of a mandate from the Department of Health and Social Care to NHS England for formal negotiations to commence.

A confidential two-part process

Since those discussions began in November, there has not been an awful lot said about them in the public domain. We know that lack of information can be frustrating. I would like to be able to share more about what is happening, but it is difficult to do that when discussions are on-going and details are often changing.

The profession is already making decisions to move away from NHS care and we need drastic action to stem that flow.

Nothing is agreed, until everything is agreed. So, to give the process the best chance of succeeding, we need to have the opportunity to discuss things candidly on a confidential basis with our opposite numbers at NHS England.

What I can tell you is that the discussions have been divided into two distinct sections: quick wins and long-term reform. Much of the immediate focus has been on achieving quick wins with the stated intention of announcing those by April 2022, which is of course now not that far away.

Whatever changes are possible from April this year, we have been absolutely clear that those cannot be the end of the process. Our focus is on the need for longer-term reform and to put it bluntly, getting rid of the UDA.

We see this parallel work on substantive contractual change as by far the more important part of this process. It is absolutely essential we see progress, or I genuinely fear that we could see the death of NHS dentistry in England. The profession is already making decisions to move away from NHS care and we need drastic action to stem that flow.

Progress ahead?

Recent parliamentary debates on the future of NHS Dentistry show our messages are getting through. This is encouraging and I would again like to thank those of you who have been active in lobbying MPs, helping to make sure they understand the dire situation we are in. We will be seeking to make sure that profile is maintained.

Parliamentary debates on the future of NHS Dentistry show our messages are getting through.

Whilst the reform discussions are confidential, what I can tell you is some of the areas we have been talking about with NHS England. I don't think any of these will come as a particular surprise, but these include: focusing on care for high needs patients; urgent care provision; fairness in terms of what activity the contract rewards; skill mix and teamwork; rewarding prevention; and making the profession feel valued and genuinely part of the NHS.

All of this represents a significant programme of work in a short space of time. The ambition is that some change might be possible from April 2022 with more significant development to come the following year.

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

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 find a better system that gets rid of the UDA.