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NHS contract is a disaster: Orthodontics is stuck in a half-way house

Blog Author Anonymous

Blog Date 24/08/2016

​For me, the contract has been an unmitigated disaster. I am an orthodontist. I took my specialist exams around the time the new contract was introduced and as a result I could not get a job because contracts were frozen at existing levels. This was extremely stressful after spending many years of time, hard work and study and losing out on potential earnings.


Eventually, I was fortunate to be able to buy two practices from retiring specialists. Two, because the first practice had an extremely low contract value and did not provide enough work for me.


Orthodontic contracts are PDS, which means they are time-limited. This means I am constantly living under the threat of bankruptcy. Because my contracts could go out to tender and be awarded to somebody else, there is always the fear of the cheapest bidder undercutting you.


I want to invest in my practices for the future, but the way the current system is set out, this makes it a very stressful and risky undertaking. Time-limited contracts are not conducive to running a business or long term management of patients, especially when orthodontic cases can take up to three years.


The Local Area teams leave it to the last minute to provide any indication of what is happening with our contracts, then they often change the terms again, at extremely short notice, making it very difficult for me to do proper business planning. As it stands, I have a contract I have been given to sign with new terms, and only until 2018.


This means I have only two years grace until I could potentially lose my contract again.


If I had some longer-term commitment from the NHS, then I could borrow money and invest more in my practices to improve the facilities, which would be my risk, not costing the tax-payer a penny. But as it is, I am left in an extremely risky financial position if I do this and the banks can be understandably, very reluctant to lend under these circumstances.


And for my patients? Waiting lists are long, because the numbers of people we can see are limited due to the constraints on my contract. This therefore limits patient choice, because they can only go to those dentists who have the UDAs (or UOAs) to be able to treat them.


This contract is horrendous for both patients and orthodontists. I hope one day we will see the back of it. I think Government needs to decide if it wants orthodontics provided on the NHS any more, and if so, it needs to fund it appropriately for the long-term.


Orthodontics seems to be stuck in a half-way house situation and patients and orthodontists are to the detriment because of it.


Anonymous, Orthodontist


Dental contract reform

We are campaigning for a dental contract that puts prevention first - find out what the issues are and what we have been calling for.