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​Dentists: NHS Targets rise as 1 in 10 practices face ‘cliff edge’

29 March 2021


Ministers commit to fundamental reform of service as new target imposed


The British Dental Association has warned government its move to increase punitive targets for NHS dentistry risks further undermining the sustainability of the sector, with over 1 in 10 practices now set to hand back the overwhelming majority of their NHS funding for the current quarter.


From 1 January 2021 practices were obliged to hit 45% of their pre-COVID activity measures or face steep financial penalties. This target will now increase to 60% from 1 April – 1 October 2021. More than half of practices are currently failing to hit the 60% mark.


Those delivering less than 36% of their pre COVID activity have faced a ‘cliff edge’, and the return of two thirds or more of their NHS funding for the quarter. NHS England estimate nearly 11% of contract holders are now in this position, leaving hundreds of practices under severe financial pressure, threatening future patient access.


Practices have been forced to operate at low capacity, to meet official guidelines designed to reduce risk of COVID transmission and ensure patient safety. Officials have indicated there are no plans to review these restrictions during the lifetime of this target. The BDA has expressed deep concern the new levels will bring footfall in practices to levels at which effective social distancing is very difficult to achieve, and stand at odds with overarching government guidance, current NHS standard operating procedures, and the clinical advice received by Ministers.


The BDA believes dentists in England have been put in an incredibly challenging position. The new target is four times the level set by the Northern Irish government, and the Scottish Government has delayed introducing one until at least June in light of the current lockdown. The Welsh Government has not introduced any activity targets at all.


The target has been widely criticised by MPs on both sides of the House for prioritising volume over need: it is easier to achieve these perverse targets through routine care, as opposed to the time-consuming urgent treatment that the BDA and NHS England say needs to remain a priority.


Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee said:


“Dentists in England have been put in an invidious position. Practices are already working unsustainably to try and meet perverse targets, and now hundreds face an existential threat.


“Patients deserve to know why Whitehall accountants are being given free rein to dictate targets that fly in the face of government guidance, NHS protocols, and even clinical advice supplied to Ministers.


“While the vaccine programme is making real headway, the restrictions we work to remain unchanged. Targets have no place during a pandemic and doubling down will only leave the future of NHS services in doubt.”


While the new target remains imposed on the dental profession, the BDA has secured some much-needed concessions. The 36% ‘cliff edge’ level will not rise in line with the target over the next six months, and dentist leaders have expressed hope that a longer time frame may enable practices to plan more effectively than the last target, which was imposed for a single quarter.


Health Minister Jo Churchill MP, NHS England and the Chief Dental Officer have also made a joint commitment to reform by April 2022 the widely discredited target-based contract underpinning NHS dentistry. NHS England is also set to take a leadership role over the reform process which has been running for over 10 years. The BDA has indicated its intention to work at pace towards meaningful system reform.


Shawn Charlwood added: “The last year has shown how the contract at the heart of NHS dentistry is unfit for purpose. There is now welcome recognition that it’s finally time to turn the page.


“We are committed to finding a way forward that delivers for patients, supports dedicated practitioners, and makes prevention a reality.”