NHS

Advanced professional decision making on the impact of the future major change in the National Health Service Dental Contract

Advanced professional decision making on the impact of the future major change in the National Health Service Dental Contract

Introduction

Contract changes that have seen more than 1,000 dentists leave the health service threaten to bring about the end of NHS dentistry, MPs will be warned next week.

The introduction of financial penalties for missing targets has already seen twice as many dentists leave the NHS as the Government estimated. Thousands more are questioning their future in the NHS because of the uncertainty surrounding their earnings,

The BDA will warn the influential Commons health committee that the future of NHS dentistry is "at risk" unless ministers scrap the system. The new contracts, introduced in April 2006, were designed to provide better access to dentists, and to simplify charges for treatment. But the BDA said they had driven more than 1,000 dentists - not the official figure of 57 - to concentrate solely on private practice because of the "financial penalties and uncertainty they face".(Chestnutt, 2009: 68)

Under the new system dentists are forced to pay back money, often thousands of pounds, to their primary care trust if they do not meet a target for the number of NHS treatments provided. (Burke, 2009: 133)

Dentists say the system is patently unfair and does not properly measure the amount of work carried out. For example, they receive the same fee for giving a patient one filling as for giving that patient five fillings.

In addition, the targets are based on the number of patients each dentist saw in 2005, meaning those with expanding or shrinking practices face having to pay back part of their salary. Dentists also complain that they have less time to advise patients on how to prevent future dental problems because of the "treadmill" conditions they are forced to work under. The future of NHS dentistry is "at risk", the BDA says in written evidence to the committee, because "dentists are facing financial penalties derived from untested targets".(Lumley, 2008: 577-85)

Choosing This Particular Aspect

I have chosen this particular topic because until now, the NHS Dentistry contract has remained focused on treatment; there has been little or no incentive for dentists to practice preventative dentistry. As outlined in the NHS Dental Contract: Proposals for Pilots (December 2010), the Government wishes to put in place an NHS dental service delivering 'high quality clinically appropriate preventative, routine and complex care' for those who choose it. Thus, it plans to develop a new national contract based on registration, capitation and quality. In moving to a capitation and quality model, the Government proposes a new way of remunerating dentists for the clinical care they deliver. Subject to the success of the pilots and approval of Parliament, the new contract is expected to be implemented in April 2014. (Grifin, 2011: 177)

Ways that Influence the Challenges Facing The Organisation/Profession

Almost 70 dental practices in England are to trial changes to the NHS dental contract from ...