Dave Cottam, GDPC Chair, outlines how the BDA worked with NHS England to confirm an abatement figure and a clearer contract structure for dentists.
After months of waiting, we finally had confirmation this week from NHS England of the abatement figures for 1 April to 8 June. This covers the period when most practices remained closed to face-to-face care, whilst some acted as urgent dental centres. The NHS had always said that it would honour contract payments, but would be reducing that overall figure to take off the costs not spent in this period. We now know that this reduction, the abatement figure, is 16.75%. It was a long road to get to this figure. We’ve had hours of discussions, meeting (virtually) two-to-three times each week in which we persisted to put forward the case for the profession. We urged NHS England to lower the abatement and to finally make longer term NHS contractual arrangements fit for purpose.
How did we get to 16.75%?
The starting point for the abatement figure calculation was the evidence we developed for the Doctors and Dentists’ Review Body year after year. This sets out the breakdown of expenses for running a dental practice.
Historically, the amount estimated for laboratory costs and materials has come to around 12.4%. We then needed to make a fair assessment of other costs not incurred during the lockdown period. This included: spend on advertising; clinical waste services; travel and subsistence; premises cleaning; equipment maintenance; postage, printing and stationery; bank and credit card charges; indemnity and insurance.
"It’s taken far too long to get here, but in the end, it feels like a fair number."
We had to come to a rough approximation of these costs, and I’d like to say a particular thank you to our friends at the National Association of Specialist Dental Accountants and Lawyers in providing us with helpful evidence. Whilst a case might be made for the figure to be lower than 16.75%, the opposite might also be argued. It’s taken far too long to get here, but in the end, it feels like a fair number.
No abatement for UDCs
The decision not to abate contract payments for urgent dental centres (UDCs) is the least those practices deserve. It recognises their dedication and commitment to patient care in extraordinarily difficult circumstances. It also takes into account extra costs for set up, PPE and staffing. We had to argue hard to ensure zero abatement for UDCs and I’m proud that we were able to achieve this outcome.
An end to UDAs in the post-lockdown period
NHS England have recognised that it is difficult in current circumstances for payments to be based on achieving UDA targets. The restrictions on practises make UDAs simply impossible. Therefore, NHS England have confirmed that in the post-lockdown period they will pay 100% of contract values in exchange for delivering on NHS hours and getting NHS care moving forward in step with any private provision. Whilst there is still an activity measure of sorts here, we think it should be achievable. NHS England confirmed our request that remote advice be factored in as well as face-to-face care. We think this is a reasonable approach and are relieved that practices finally know how they will be paid in the post lockdown period.
What will future contract arrangements look like?
This current arrangement won’t be around for long and our next job is to agree what the NHS contract should look like for the rest of this financial year.
"I’m confident that the profession will do the right thing... and pay associates and other staff the appropriate NHS income."
As our discussions with NHS England continue over the coming weeks we will again be pushing for a balanced approach that recognises ongoing constraints and increased cost pressures. It must also be flexible as the pandemic’s progression is unlikely to be predictable or consistent across England.
Whilst there are some specific requirements on practices, this interim framework relies on trust. I’m confident that the profession will do the right thing in providing high quality patient care and will pay associates and other staff the appropriate NHS income. If we get this period right, it will set the tone for what we can agree for the rest of this year and beyond. We might even see some good come out of this awful pandemic in the shape of longer-term NHS contractual arrangements that are finally fit for purpose.