In the past few years we have witnessed significant changes in the NHS dentistry. A new format of NHS/PCT contracts was introduced five years ago, bringing with it much consternation amongst practitioners. And this autumn a new scheme is being trialled in selected practices.
In 2006 the aim was to offer a better service to patients by offering a simplified pricing structure and an increase in preventative treatment whilst reducing the incentive for dentists to undertake unnecessary treatments. Under this new structure dental contracts are based upon UDA’s (Units of Dental Activity) in return for an annual contract value. Thus, dentists essentially have a UDA target to meet each year as agreed in their contract.
This replaced the historic system whereby a practice received payment on a piecemeal, fee per service arrangement. Whilst there used to be over 400 different prices, under the revised contracts the pricing of treatment falls within one of only three different bands. This reduction in complexity is on the face of it a good thing from a patient point of view as you pay the same for three fillings as you do for one. But this does make the cost of one filling poor value for money.
Despite best intentions, the British Dental Association claims that under the present contract system dentists
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are becoming increasingly disillusioned with their profession as a result of excessive administration with not enough time to provide patients with preventative dental care, rising costs and endless problems with their dental contracts.
The criticism of the 2006 contract is that dentists are paid according to how many treatments they carry out, with individual targets, resulting, in extreme cases dentists having to stop seeing patients in January because the practice has filled its quota for the financial year. In other instances dentists have to refund money when they fall short of their target. Ironically many believe that the current system has led to a “drill and fill” mentality which is what the present contract policy was meant to prevent!
Another failing of the current system is that many patients are not registered with an individual practice. Research has shown that in the past two years one million people failed to see an NHS dentist. In addition, over the last 10 years there has been a 40% increase in emergency admissions due to dental problems. Indeed, around 25,000 people were treated in hospital for dental problems in 2009, up from 17,400 in 2000/1.
As part of the proposed NHS Reforms, the Coalition Government has announced |
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plans to trial new changes to the current dental contracts in 68 practices across the UK. It is hoped that this will improve the oral health of patients through the promotion of preventative treatment, with a particular emphasis in reducing tooth decay in children, by encouraging good habits early on.
A major criticism of the current contract system is that it leaves dentists concentrating on activity with no specific rewards for high quality care or for delivering prevention. Therefore under the pilot scheme dentists will be paid for the number of patients they care for and the health results, rather than the number of courses of treatment dentists perform. A capitation formula will be developed to recognise the differing dental needs of their population – i.e. elderly patients tend to require more restorative work than children who require more check-ups. Dentists will maintain a detailed record of their patients’ oral health to monitor over time the improvements in their oral healthcare.
The introduction of the pilot schemes has been met with approval from the BDA and it will be interesting to follow the outcome of these trials and see how they might shape the future of NHS dentistry.
For further information contact Peter Gregory MRICS tel: 01908 608002 or email: peter.gregory@argroup.co.uk |
