From a personal perspective, the 2006 contract penalises me financially when I take over the care of a patient with high needs. The greater the need, the higher the cost to my business. I feel this is unfair to me as a professional and unfair for my patients.
Also the nature of the "course of treatment" means that I am pretty much obliged to do any and all treatment regardless of my ability or confidence. With the exception of oral surgery, the back up from specialist services in the NHS is woeful.
If I do not feel able to do a root filling there is nowhere except private specialists to refer to. I cannot refer to a colleague with an interest, as this effectively means one of us is working for free, as splitting the UDA is not feasible. That is before we consider how derisory the UDA rating for endodontics is. Complex restorative is also very difficult to access.
Patients have demands, but if I am not able to do the work where do I send them? Hospitals reject them and lands the problem back with the dentist – I feel I am being forced to 'have a go', which leaves me massively open to legal and GDC action and our regulator has no qualms about hammering the individual when something goes wrong.
The commissioners won't give us clear guidance on what and cannot be done on the NHS. The old system wasn't perfect, but at least it was clearly defined. Patients now are the ones who truly suffer when dentists try to 'make it work'.
Skilled dentists cannot get access to the funding to provide the necessary treatment. There has been no real increase in funding since the 2006 contract came in and I have seen my indemnity costs rise to £4,000 a year, and the GDC fee is now nearly £1,000, yet I am still on the same UDA value.
I balk at the term 'greedy dentists. I work so hard and invest my own money into developing my skills and running my business and yet I get no thanks for doing so.
How can young dentists open new practices in this environment? An expectation to hit at least 95% of UDA target from the start with a list that has no patients to begin with, and then they are very likely to have lots of high need patients that will demand a lot of clinical time, placing great demands on the ability to complete the UDAs. It is a nightmare scenario.
Established practices might have the UDAs, but they may not the space to take on extra capacity.
Dentists and patients suffer while successive governments spew out sound bites and the press delight in vilifying us. I am not a greedy dentist, I am a highly-skilled professional, trying to do the best for my patients under a system that is broken.
Anonymous, Practice Owner
Dental contract reform
We are campaiging for a dental contract that puts prevention first - find out what the issues are and what we have been calling for.