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Dental contract reform: our asks for 2019

Blog Author Henrik Overgaard-Nielsen

Blog Date 07/01/2019

 

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We continue to push for a reformed NHS dental contract that works for both patients and the profession.

As you might be aware, prototype practices in England have been testing a new clinical pathway and remuneration model for the last few years.

The contract payments are based on a combination of capitation, continuing care payments for maintaining a patient list, and activity payments.

These prototype practices are currently testing two different 'blends' of contracting, each using a different proportion of activity and capitation:

Blend A

Payments in Blend A are made up of roughly 60% capitation and 40% activity.

Activity is paid for Band 2 and 3, and capitation payments cover all activity that would have been done under Band 1.

 

Blend B
Payments in Blend B are made up of roughly 85% capitation and 15% activity.

Activity is paid for Band 3, and capitation payment covering all activity that would have been done under Band 1 and 2.


What is the BDA doing to influence NHS dental contract reform?

The General Dental Practice Committee (GDPC) has been working hard to influence the contract reform process and to secure improvements to the prototype model, so that it works for dentists.

We've been negotiating on a number of issues and the National Steering Group has made some recommendation for the final roll-out:

 

1. Three-year capitation period

A practice will be paid capitation for a patient for three years after the patient's last non-urgent course of treatment, unless the patient moves to another NHS practice. Every time the patient returns for a non-urgent course of treatment the clock resets for another three years.

 

2. Weighted capitation

Capitation payments per patient will be weighted depending on patient needs. The proxy for patient needs will be the patient age, sex and deprivation; with deprivation based on the patient's postcode.

This should help to incentivise practices to take on high-needs patients, and we would expect the difference in capitation payments to be two or three times the amount.

That means dentists would be paid three times as much for the 'highest needs patient', compared to the 'lowest needs patient'.

 

3. Different options at roll-out

The programme is still aiming to start roll out in April 2020 and at that time practices should be able to choose to stay with the present UDA contract or, to choose to change to the reformed contract, possibly with two options, either Blend A or B.

The GDPC takes the view that we want to see only Bend B rolled out (see below).

 

4. National tariff for capitation and activity values

The GDPC has called strongly for there not to be a transfer of the inequities of UDAS into a reformed dental contract. We agreed to recommend a national tariff for capitation and activity values.

Contract values will stay the same, so this means that some practices will have to see fewer patients, and some more patients, and will have to do fewer, or more, UDAs.

The activity payment should be reduced by 20-30 per cent in the reformed contract so we expect very few practices will have to do more activity than they are doing now.

 

What do we want for dentists?

We've called for a number of further changes, that we believe need to be made for the reformed dental contract to be fit for roll-out:

 

1. Item of service

UDAs are hugely discredited, and we've made the case for them to go.

We want them replaced by an item of service, especially since we believe this will incentivise taking on high-needs patients.

The Department of Health and Social Care (DHSC) states that it is not possible for it to conduct the necessary analysis for this ahead of a 2020 roll-out, and therefore want to delay any change to the activity measure until after the initial roll-out.

We are questioning this and pushing for a resolution as soon as possible.

 

2. 100 per cent capitation

Dentists want to do the job of dentistry. We are conscientious and caring healthcare professionals and if we could just get on and treat our patients (and be fairly remunerated for it), then our patients would get the care they need.


We believe that dental reference officers should be employed, to ensure that the rules are being followed and patient care is being delivered to the highest standard possible.

If we really want to incentivise prevention, we believe the best way is to have 100 per cent capitation, and let us get on and do our job. The current system makes no-sense, when we are technically incentivised to do fillings and crowns. 'Incentives' to just drill and fill is what we have been arguing against for many years.


3. Blend B only

If we cannot have 100 per cent capitation now, then we only want blend B to be taken forward as this has the highest level of capitation and we believe is the most appropriate to deliver on prevention.

If DHSC insists on having Blend A as well then, the choice of A or B must be for the practice, not for commissioners – we believe it's the dental practitioners working on the front line who are best placed to make this decision, based on their patient cohort.

 

4. Financial stability and viability of dental practices

We have strong concerns about practices being left in 'financial limbo', if and when they transfer to the reformed dental contract.

We have been arguing for a long run-in time, as well as guarantees and support to ensure practices continue to be financially viable and there is stability.


5. Reduced activity targets

The prototypes have had a reduction in activity targets of 20 per cent for Band 2 treatments and 30 per cent of Band 3 treatments.

We believe a 20-30 per cent reduction in the activity on the lines of the reduction is needed due to much more time spent on prevention, which at the moment doesn't count as activity, and also that treatment need is reduced, because of all the preventive measures.

This must be transferred into the reformed contract.

 

6. Reduction in capitation targets

A substantial number of prototypes are having difficulties in hitting their capitation targets.

The Government must acknowledge that prevention takes more time, and we therefore need a reduction in the capitation targets.

The amount of money paid per patient has gone down by almost 15% in the last five years, we simply need the Government to re-instate the amounts paid five years ago.

 

Getting the best for our patients

It feels like we are so close, and yet still quite far, from getting what we need to give our patients what we know is possible.

We will continue to fight on your behalf, to ask the Government to see reason and acknowledge that dentistry needs to be taken seriously, be appropriately-funded and to let dentists get on, and do what they do best.

Henrik Overgaard-Nielsen, Chair

General Dental Practice Committee

 

Working for you

We will continue to campaign for a reformed NHS dental contract. If you'd like to be kept up to date with our progress:

Through our policy and campaigning work, we ensure that the concerns of all sections of the profession are raised and that dentists' voices are heard at a national level.

With each new member, our voice and our influence grows. Add your voice, join today.