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Dental contract reform: let's move forward

Blog Author Dave Cottam

Blog Date 12/12/2019


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It feels like progress may have been moving at a snail's pace, but we are still pushing hard to get a reformed NHS dental contract implemented from April 2021.

I spoke to Local Dental Committee (LDC) representatives at the recent LDC Official's Day and outlined the key points we have been negotiating on and you can read our core asks here – we are keen to move forward and ensure that any new dental contract works better for both the profession and our patients.

It is being recommended there will be national weighted capitation fees for each patient on a dental practice's list but the General Dental Practice Committee (GDPC) remains concerned that the method used to calculate the weighting does not adequately reflect the extensive treatment needs of some patients.

This activity fee would be based on an agreed national figure. However, while these principles have been agreed by the Contract Reform National Steering Group, the levels at which these national rates will be set at is still to be negotiated and will be crucial. NHS England and the Department of Health and Social Care have still to agree to actually implement dental contract reform.

We have continued to point out that the financial model needs to be modified to make it viable and sustainable for practices, and ensure patients get the best deal.

Around a quarter of all the practices that participated in the 'wave 3' prototypes had experienced clawback in 2017-18, this is a significant problem and it has to be addressed.

We have called on the Department of Health and Social Care (DHSC) and NHS England to adopt a flexible approach to patient number targets, to allow practices the time needed to implement the new preventive approach. This is something we've made clear in our Manifesto for Oral Health in the run-up to the General Election.

The GDPC also wants the so-called "exchange mechanism", which allows practices to swap activity for patient numbers, to work in the opposite direction as well, so that patient numbers can be exchanged for doing more activity.

We argue that these changes will give practices greater flexibility that can help them to deliver on their contracts.

We've also urged the DHSC to ensure that the appropriate transitional arrangements are in place for practices joining any reformed contract.

We believe that adapting to the new clinical pathway and remuneration system will take time and practices will need some breathing space to gain or lose patients depending on their new targets, which cannot be done in a rushed timeframe.

We're calling on NHS England and the DHSC to acknowledge that a reformed dental contract needs a carefully managed introduction.

We believe a staged approach would help reduce the risk for dental practices while still providing value for the taxpayer by way of better patient care, and also ensure there isn't an exodus of dentists leaving the NHS, as happened under the 2006 contract implementation.

Dave Cottam, Chair
General Dental Practice Committee

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