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​Orthodontic Procurement: "for many not bidding may be better option"

23 February 2018


The British Dental Association (BDA) has condemned the NHS orthodontic procurement exercise launched this week for the orthodontic agreements across the whole of Southern England which are set to expire on 31 March 2019.


Despite winning several concessions, including on UOA pricing, the BDA has expressed grave doubts about the outcomes:


  • The price banding for which tenders will have to be submitted is at £54.89 to £58.89 - compared to current average value of £64. In the first two years, 100 per cent of contract value is not paid to any new bidders even though target UOAs must still be delivered. Following discussion with NHS England in February the lowest level of UOAs allowed in the tender has been raised from £51.89 to £54.89 - but we still do not feel it recognises the true cost of orthodontic care;
  • bidders deemed to be at high financial risk will be excluded from the process but given the relatively low UOA values on offer, practices will be at greater financial risk because expenses may not be covered;
  • the practice must have a least one dentist on the GDC specialist register which will exclude many current providers. Care and treatment must be personally supervised by the specialist;
  • in the draft tender information, providers taking on patients previously treated by another provider would have received no UOA credit. The BDA together with the BOS managed to soften this provision slightly;
  • Lot sizes are large and may favour larger providers;
  • The BDA has been told by NHS England that the model of providing care is now based on orthodontic therapists. We do not believe this is true across the country and there are not enough therapists to work in every practice.  If services are specialist led then non specialist dentists may well not have a role except as a practitioner fulfilling an orthodontic therapist's role;
  • The public consultation was flawed, in that it did not disclose plans to patients, and feedback from 1600 respondents has not yet been shared.

A Judicial Review entered into by the BDA and the British Orthodontic Society on the tendering process remains ongoing but stayed.

The BDA is advising providers to consider very carefully the financial impact and the viability of their business model before bidding, and to take advice from their accountants.


The BDA's chair of General Dental Practice Henrik Overgaard-Nielsen said:


"This tender feels like a race to the bottom, and providers will have to go through much soul searching before choosing to take part.


"We are telling our members to speak to their accountants. It is not a message we take any pleasure in delivering, but the fact is that not bidding for tenders may be the better option for many.


"We do not feel that dedicated health professionals should be asked to choose between the devil and the deep blue sea. And our patients, particularly those in rural areas, should not risk losing their regular orthodontist and driving huge distances to secure access. These savage cuts may well impact on practices, personnel and our patients to an unacceptable extent. It simply won't be in many providers' interests to bid when conditions set will mean they take up to a 30% hit in pay."


Concerns about orthodontic procurement: what you need to know

Further information for members is available on our orthodontic procurement campaign page. Expert and Extra BDA members can also contact our Advisory Services team for further advice.