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​Dentists: Imposed targets to push NHS services in England to the brink

17 December 2020


The British Dental Association has warned the government now risks devastating NHS dental services in England, as ministers prepare to impose a system of targets the majority of practices will be incapable of meeting under COVID restrictions.


The dentists’ union has today announced it has refused to sign up to the deal which is expected to see practices face steep financial penalties if they are unable to hit 45% of their pre-pandemic activity measures. Dentists in England are currently receiving their former NHS contract value, on the condition they continue to spend the same time on NHS care as they did pre-COVID.


Under the likely arrangements, 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. The targets do not capture an estimated 25% of activity covering remote triage taking place over the phone, which remain vital to ensuring staff and patient safety.


Analysis of new NHS England contract data seen by the BDA suggests in November only a minority (43%) of NHS contract holders are likely to escape penalties. 41% of contractors are currently operating below 36% of their targets and so face the ‘cliff edge’, leaving hundreds of NHS practices at real financial risk. 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.


The BDA has expressed grave concerns that 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. It has stressed that the widely discredited target-based system the service operates to is incompatible with providing safe and sustainable services for patients during the pandemic.


Dentists’ leaders say the move will force dentists to shift focus from the heavy backlog of priority urgent cases to high volumes of routine check-ups. The Unit of Dental Activity (UDA) target system - a crude measure deemed "unfit for purpose" by the Health Select Committee - places the same value on performing one filling as doing 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 1 UDA.


Over 19 million NHS appointments have been missed in England this year, and the Association has urged the government to provide capital investment to restore capacity. "Fallow time" restrictions - the gaps dentists are mandated to keep between treatments to minimise the risk of viral transmission that remain the number one barrier to increasing access - can now be reduced through improved ventilation systems. While the Welsh Government has recently offered ring-fenced support, no similar commitments have been offered by either the Department of Health or NHS England, and the majority of practices are unable to fund equipment and building works independently.


England is now an outlier. 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 100% of their 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.


Dave Cottam, Chair of the British Dental Association’s General Dental Practice Committee said:


“By imposing targets that simply cannot be met this government is pulling away the life support from NHS dentistry.


“This move will actively undermine patient care. Ministers are instructing dentists to churn through routine appointments against the clock, rather than deal with a huge backlog of urgent cases.


“Dentists wanting to do the right thing by their patients will now be punished for it. To stay financially viable we are being made to choose the worried well over people in pain.


“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.


“Practices struggling to stay afloat 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.”