The government’s move to impose new targets in England will pull the life support away from NHS dentistry and undermine patient care, argues Dave Cottam, GDPC Chair.
Today we have refused to sign up to a deal which will see practices face steep financial penalties if they are unable to hit 45% of their pre-pandemic UDA targets.
For some months now we have been in negotiations with NHS England regarding the future of the support package for contract holders in England. Now, the government have decided to press ahead with a target that will threaten practice viability and undermine patient care.
Those that fall just below 36% of the activity target are expected to face a 'cliff edge', where they would have to return a significant majority of their NHS funding for the period from 1 January to 1 April 2021 and face potential breach of contract. This is a crucial step backwards for practices already struggling to stay afloat. In a nutshell - practices will face huge financial penalties chasing impossible numbers.
This logic has no place in a 21st-century health service in the middle of a global pandemic.
Here’s what you need to know about the new UDA targets:
1. These are numbers that cannot be met
“They are setting targets that swathes of contract holders simply cannot meet.”
Whether it’s artificially inflating patient numbers, or trying to boost patient charge revenue, NHS England have chosen the wrong course.
They are setting targets that swathes of contract holders simply cannot meet.
NHS England’s own contract data, which we have seen, suggests in November only 43% of contract holders are likely to escape penalties.
Meanwhile, 41% of contractors are currently operating below 36% of their targets and consequently will face the 'cliff edge'. That leaves many practices at real financial risk.
Remote triage, quarter of current activity, isn’t being counted, even though it’s vital to ensure staff and patient safety.
Most dental practices provide a mix of NHS and private care and many are already suffering due to a lack of support for private dentistry throughout the pandemic. This will push some practices over the edge.
2. Patient care will suffer
“Dentists wanting to do the right thing by their patients will now be punished for it.”
This move will not benefit the patients who need us most.
The fact is these targets will force dentists to shift focus from the heavy backlog of priority urgent cases to high volumes of routine check-ups. As we know the UDA system (dubbed 'unfit for purpose' by the Health Select Committee) places the same value on performing one filling as ten.
Providing time-consuming urgent treatment, including potentially multiple fillings and an extraction, enables a dentist to achieve 1.2 UDAs for the entire course of treatment, whereas a routine examination provides one UDA.
Dentists wanting to do the right thing by their patients will now be punished for it. In order to stay financially viable, we are being made to choose between low-risk cases and people in pain.
This move will mean an increased patient footfall to levels that are potentially unsafe, and in tension with both overarching government guidelines and NHS England standard operating procedures.
Any target-based system the service operates to is incompatible with providing safe and sustainable services for patients during a pandemic.
3. Practices are not being offered any support
This year official restrictions slashed our capacity, yet there is no hint of investment to help us secure equipment that could get more patients through our doors safely.
Most practices can’t afford the ventilation upgrades now required to bring down fallow time. The Welsh Government has already pledged capital investment in response to our call, but the authorities in England have not budged.
More than 19 million NHS appointments have been missed in England this year. We need help to reduce fallow time, not arbitrary targets.
4. England is an outlier
No other UK nation has taken this path.
Wales operates the same NHS model for services but has set no target. The Welsh Government is providing NHS practices capable of providing a full range of treatment with their full contract value. In return, practices are rightly asked to work through the backlog of patients as best as possible on a prioritisation of needs basis.
The 45% target for NHS contractors in England is more than double those set by Northern Irish and Scottish governments.
5. There is an urgent need for clarity
Bringing in these targets now - on the cusp of Christmas - will leave practices facing so many questions: How will associates be paid? Which patients should be given priority? How can practices maintain their long-term financial sustainability?
We deserve better than this. The start of the new year is now only weeks away and you should have been given adequate warning to react to this significant change. However, in light of this, the BDA is doing as much as we can to offer advice and support to our members.
We have already created a comprehensive guide for members
and will continue to update our advice and keep you informed of all progress as it unfolds.
A broken NHS contract remains the elephant in the room, and we will not relent in our bid to secure the change our members need.
Chair, General Dental Practice Committee