England: Marginal changes under scrutiny
20 July 2022
The changes announced by government to the NHS contract failed to live up to their billing.
The claims from NHS England that "patients across the country will benefit from improved access to dental care" have been rapidly shot down by dentists, MPs and the media.
We're clear the changes to NHS contractual arrangements announced yesterday do not even begin to address the system's fundamental flaws. The package includes:
A minimum UDA value. The payment dentists receive for hitting a target will now be set at a minimum of £23.00. Only around 3% of practices will benefit, and any increase will not reverse a decade of savage cuts in the service, which can leave practices providing NHS care at a financial loss, particularly to high-needs patients.
A higher reward for treating 3 or more teeth. Dentists will now receive 5 UDAs for treating 3 or more teeth, an increase on the current level of 3 UDAs which applied to any number of teeth. Given patients are now presenting requiring as many as 20 fillings, perversity will remain baked into the system, with less complex work still rewarded at the same rate as treatments that take hours.
A new payment rate for complex treatment. Root canal treatment on molar teeth will now be rewarded with 7 UDAs, as opposed the current 3, as a result of our lobbying. However, it's unlikely to be a game changer, given the nature of the challenging and time-consuming treatments – which can take up to 3 hours on a single tooth.
The national press has taken up our concerns, with many focusing squarely on plans for 'personalisation of recall intervals', and speculating on the death of annual check-ups.
We've pointed out the facts. NICE guidance - in place for 18 years - isn't changing, and the overwhelming majority of dentists are complying with it in any case. This is another attempt to conjure up more capacity without adding any new investment.
We've worked to ensure MPs have understood the limitations of this package from the get-go.
Within an hour of the announcement former Lib Dem leader Tim Farron was pressing the new Health Secretary on when the UDA would finally be history. Labour's Stephen Morgan put it quite plainly that these changes fail to 'grasp the nettle'.
And on funding we have real concerns. The government is presenting this package as a 'first step', and suggest they will continue to pursue change in line with their 'six tests'.
The last of these tests – affordability – means working within the limits set by the Treasury. The others – including improving access and retention are laudable goals, but simply cannot be delivered working to a budget slashed by a decade of cuts.
Dentistry has already featured prominently in the Conservative leadership debates. We don't know which team will be running Downing Street, the Department of Health or the Treasury, come September, but we will continue to press for fair funding and real reform.
Some of these measures require parliamentary time, so will not take force till the autumn. We will of course be providing members with all the advice they need as the details become clear.
NHS England will be holding a webinar on these issues on 27 July. Register here.
Our advice team have meanwhile outlined everything you need to know if you are considering supporting your income by offering private treatments, either exclusively or alongside NHS work.