Our experience as a prototype leads me to believe the reforms due to roll out from April 2020 could have a favourable outcome on dentistry – both for patients and practices.
From a patient perspective, the quality of service they receive under the reforms is better than under the current UDA model. We follow a preventative-based care pathway which allows us to plan treatment for patients over a period of time rather than in definitive courses of treatment.
Because patients are becoming ever more dentally aware and oral health is generally improving across the country, there is now less of a need to carry out activity on patients. The profession will therefore naturally become more focused on prevention. Most, if not all, of the prototypes have found that in order to make it work they have had to bring in more patients to fulfill their contract in order to compensate for the drop in activity that results from spending more time on prevention. However, there are still areas with high dental needs and the system needs to work for Practices in those areas too.
A common feature in the prototypes is the use of skill mixing, using therapists and oral health educators to promote the prevention aspects of the approach. Dentists get more time to do the more complex work and treatments that therapists can’t do. Staff job satisfaction may improve as they feel a sense of ownership and achievement in their contribution to improving the oral hygiene and lifestyle of a patient.
A new remuneration system
I’ve always felt the UDA system doesn’t work effectively for many practices and is an unfair way of providing dental care. In fact, a big part of why we went into piloting was the advantage of getting away from UDAs. It is apparent that it is not an effective system because it’s purely activity-based. Although the prototypes still use UDA’s as a measure of activity, there is more emphasis on capitation, particularly the blend B version, where it is common for the capitation element to comprise over 85% of the contract value.
So, many NHS practices may find much to gain from the contract reforms, provided the final remuneration system is fair and reflects value for money. I believe there is still much work to do on the remuneration system and I hope NHSE makes the necessary changes to make it viable for the majority of practices. Practices also need to be able to manage themselves well, as there are more balls to keep in the air. You have both UDAs and patient numbers to balance and the skill-mix model can be more challenging to manage, but if done successfully I believe the care pathway is potentially a better model for providing dental care for patients and also more rewarding and satisfying for staff.
Working with Dental Partners
From a personal point of view, I’m excited that at this important stage in the journey we are now on board with Dental Partners, a practice network that already has a fantastic knowledge and understanding of the reforms and are well prepared for this new era in NHS dentistry. I’m greatly looking forward to being a part of Dental Partners as the company continues to develop, and assisting other practices that move over to the contract reform model in the future.
Paul qualified from London in 1983 and also has a MSc in Advanced General Dental Practice. He has a special interest in implant and restorative dentistry and has 2 papers published in the BDJ and Dental Update. He is a member of the National Steering Group for Dental Contract Reform.
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