What's the deal?
The debate around the current NHS dental contract, including the issues around UDAs and their values, is well-rehearsed and the dental profession as a whole agrees that change is needed. But which specific direction the change should take remains a point of conjecture. Whilst the emphasis on prevention and oral health is welcomed, exactly how this fits with a suitable remuneration package is still up for discussion.
Reform has been long-awaited. Three years ago the contract was the subject on everyone’s lips, but as often happens with big news stories, the spotlight shifts to fresher stories and people move on. It’s important to remember though, that however slow, progress is being made. Eighty two prototype practices are now working on various types of contract and progress reports are being published intermittently. Ultimately in whatever form it takes, the contract will have a big impact on the whole profession and when making plans for the future, keeping up to date with the debate is crucial.
The story so far
Elements of a proposed reformed contract were piloted in 2011. The pilots were based on capitation and quality, with care being provided through a preventive care pathway. The approach was popular with both patients and dentists, but it actually resulted in a decrease in access for patients in most of the pilot schemes.
In 2015, the Department of Health introduced the ‘Prototype Remuneration Model’, and since then, dental practices have been trialling different versions of a system based on this which still includes activity targets. The two prototypes have different weightings of capitation and activity on the three treatment bands. Remuneration of the contract is then based on the practice’s performance in their blend of capitation and activity.
In terms of patient care and the contract’s focus on prevention, there seems to be a general acceptance of the need for this. The ‘traffic light system’ for the care pathway has so far had mixed reviews, with the general consensus being that the idea is good in principle but that there are challenges in many areas, including the time it takes to follow the pathway, the transfer of some responsibility for maintaining oral health to the patient and the application of the pathway to some groups of patients who have particular needs, such as edentulous patients.
There’s no crystal ball
Despite serious reservations, it seems that the final reformed contract will be a hybrid of the two prototypes which will remunerate practices based on activity and also capitation, but nobody quite knows what form it will take.
We are also in the dark as to when it will come into force, with current estimates suggesting 2020 at the earliest, but probably later. There is a professional will to push through the contract reform, but it will require political impetus, and Brexit and other health service priorities continue to nudge the dental contract further down the priority list.
One thing that does seem to be certain is that there will no longer be lifetime contracts. Sara Hurley, the chief dental officer for England, commented recently that they would be time-limited to bring them in line with other government contracts.
Reasons to be fearfulUncertainty is never good for a business as it creates a challenging environment in which to plan for the future and it’s difficult to prepare yourself for change if you don’t know what that change will look like. Timelimited contracts are bound to have an effect on the value of a practice as they will introduce a further level of uncertainty into the purchase of an NHS or mixed practice. Also, a practice that is underperforming in relation to its contract will be less attractive to a potential buyer.
With no crystal ball to consult, I always advise practices to add as much value into their practice as possible. By ensuring they are running efficiently, that they have a well-trained and motivated team of people, a healthy list of loyal patients and a well-equipped and fit-for-purpose building, a practice owner can, to a certain extent, forge their own path without the vagaries of external influences.
What is certain is that change is coming, so stay informed, consider what it may mean for you and get your practice in the best shape to withstand any shocks that may hit when the contract finally lands.
Posted by: Peter Cummings on 07 Jun 2018