What the changes to the NHS contract mean in practice
Following 12 months of discussions and negotiations, the next two months will see dentistry witness the most significant variations to the NHS Dental Contract in 16 years. But do these changes improve the fate of the profession, patients or both, or do they signal a much heralded, but ultimately ineffective series of ‘change for change’s sake’?The amendments have been introduced to address some of the perceived problems with the current system, and NHS England believes they will result in improved access to NHS dental care across the country.
NHS Dentistry Changes – a summary:
- Amendments to UDAs (Units of Dental Activity) for specific procedures designed to support ‘higher needs’ patients
- Establishing a new minimum UDA value
- Improved use of dental therapists to provide fillings, sealants and preventive care by removing administrative barriers
- Clearer information for patients around NICE (National Institute for Health and Care Excellence) recommended recall intervals
- Amendment to FP17 form to help peer review, assessment of a patient’s oral health risk and monitoring of personalised recall intervals
- Funding for high performing practices to provide more activity, where affordable
- Improved patient information provided via the NHS Directory of Services
The UDA system plays to the heart of practice efficiency, so the changes effective from 21st November provide a more realistic remuneration for clinicians undertaking more complex work, often required by higher needs patients. The need to cover the overheads of a practice by being able to generate a realistic hourly rate is a cornerstone of profitable business. The question of whether these changes go far enough remains, but this is at least an acknowledgment of the existing problem.
The minimum UDA value will rise to £23 per unit from 1st October 2022. It will be introduced via a reduction in the UDA target of affected practices. However, a reduction in UDA targets could be said to represent an effective cut to patient access, putting more pressure on practice teams trying to accommodate patient demand. The BDA states that this modification will benefit only around 3% of practices and will therefore have little impact on the financial challenges being faced by many.
There will be more work to promote the skills of dental therapists which appear misunderstood by both the profession and the public. In 2013 the GDC removed barriers to Direct Access, enabling therapists and hygienists to see patients without the supervision of a dentist, so long as they were operating within their scope of practice. However, uptake of this model was relatively poor, yet it is widely recognised that using therapists can be a highly efficient way to reduce appointment backlogs. The amendment to FP17 and IT forms will enable therapists to open a course of treatment, allowing them to work more independently, therefore remove some barriers that are preventing a more streamlined workflow.
Recalls are the backbone of efficient practice and effective dental care. However, the traditional recall interval of six months is arguably not necessary for all patients. By better enforcing recommended recall intervals NHS England believes it can focus on ‘higher needs’ patients. This change will necessitate improved communication with the ‘worried well’, who are considered as being at low oral health risk. It’s recognised that personalised recall intervals will require a cultural shift for some clinicians and patients and to support the change, information materials will be provided. The use of automated recalls remains an important tool in reducing administrative time and arguably increases in importance given that some patients may have 12 or even 18 months between examinations. In addition, practices will need to attract more patients in the next 6 to 12 months in order to fill spaces in their appointment book left by the extension to recall intervals for some patients.
Amendments to FP17
There are several changes being made to the data input into the FP17. For instance, data will now be collected on the number of untreated decayed teeth and the recommended recall period. The way in which these statistics will be used is subject to discussion, with some suggesting that it will used to identify deviation (or the lack of deviation) from national norms and recommended guidelines. Whatever way in which the data is used, having it held within a practice management software system ensures that forms are completed fully and correctly and streamlines administrative activity for the whole team.
Increased activity, where required
New changes will enable commissioners to reallocate funding from practices unlikely to fulfil their whole contract, to those which can deliver additional activity, up to a maximum of 10% of their contract. There are a number of caveats to this change, which will be, in the first instance, a voluntary reduction, but is aimed at providing NHS access in areas in which provision is available. These changes make it more important than ever to accurately track UDA activity for each provider so that any shortfalls in performance can be addressed. It also puts more emphasis than ever on running an efficient and streamlined practice so as to avoid any UDA shortfall.
Improved patient information
Practices will be required to update their information on the NHS Directory of Services on a quarterly basis with the aim of making it easier for patients to find a practice. Keeping all patient facing information up-to-date, including that on the practice website, is an important part of effective communication that will help to attract and retain patients.
It is NHS England’s view that these changes represent the first step in making the dental contract fit for dentistry’s needs. Practices that will benefit most from these adjustments are those which are able to integrate amendments within a streamlined patient journey, creating more efficient workflow processes.
If you are unsure about how the changes affect your practice or want to make the most of new opportunities, please contact us for a Business Health Check.