Time is running out - it’s a strange phrase and I often wonder which part of the world will come to an end when time finally runs out. For the dental community, I wonder if dentistry will still exist when time runs out. The most recent conundrum in dentistry focuses on time; that is the timing of the next NHS contract and also whether or not this new iteration will be time limited.
Time is a big feature within healthcare and this is no different in dentistry. Time is one of the components of the disease pathway, without it dental caries would not occur and we all need time to do our work. In dentistry, time is just as much a currency as is a UDA, this is not always obvious but UDAs also translate to a component of time. NHS dentists often discuss the number of UDAs that they need to achieve in a day or the amount of time it takes to carry out a procedure such as root canal treatment.
The timing of the new contract will be important to politicians and will also be important to those either thinking of selling their practices or retiring from the profession. A new dental contract that is based on capitation has a feel good factor about it, it plays to the perceptions of the public and it may even give dentists a little more autonomy over the way they treat patients. These are all good vote winners and if the Government opted for such a contract then there could be every possibility that it may be introduced before the next general election. Then again if the Government proposed a model that is based on capitation with some constraints then this may not be seen as being as favourable and could be introduced after the next election.
The other storm that has been brewing is around time limited contracts. There seem to be some policy makers that believe that time limited NHS contracts provide better value for the public. It may well be that they could provide better value, however at the present time this seems unlikely based on the funding arrangements. It would be hard to imagine that most banks would lend to small businesses carrying so much risk from time limited contracts. If the financing of dental practices came to a halt then it would not be surprising if both quality and choice reduced. The dental market could become dominated by very large suppliers who may find it easier to leverage investment.
The NHS is facing enormous challenges, commissioners are struggling to secure extra funding and it seems like that NHS budgets will not grow in the near future. Whilst it would seem attractive that the NHS dentists continue providing everything to everyone, this seems unsustainable. Has the time come to ration the type of treatment available on the NHS? This is not a new concept and already exists in a number of forms ranging from referral management to exceptional commissioning or individual funding requests.
Health changes in any population usually take time to manifest, a change in the way that the oral health services are delivered now may not be realised for another 10 or 20 years. Anything involving government is seldom straight forward and generally is tied up in political point scoring. In my view, a new contract should be introduced at a time which is right for patients and the public; and the contract should reflect the long time horizon involved in healthcare as well as the risk that is borne by small independent providers.