The UDA has been the measure of dental activity for four years now and practices in England and Wales are still trying to work out if they are being paid fairly for what they do. The UDA has almost universally been detested by practitioners since its introduction in 2006. Whilst many would like to see its demise, the health department appears to be keeping faith with its currency.
The UDA has many flaws, not least that it’s the main measure of performance used to date. How can a treatment plan that involves an examination and occlusal amalgam be valued the same in UDA terms as an examination and molar RCT? This comparison does not make sense. It is not only dentists who find this odd, even patients look surprised that the hour-long RCT that is being undertaken is charged at the same price as that filling they had earlier in the year.
The department, I suspect, considers it to be one of those ‘swings and roundabouts’ situations - to some extent I understand the rationale given the variations from one patient to another in what’s appropriate as a course of treatment. One patient may require a molar RCT (and a concomitant restoration) which attracts just three UDAs, whilst another may only require a restoration. Thus the molar RCT may be counterbalanced by the single occlusal restoration in another course of treatment, however, it is not a comforting thought when you have used your rubber dam and thrown away your expensive rotary files.
Another anomaly with the UDA is the differential in UDA values across the country. The department says the UDA value is based on what was achieved during the test year before the new contract came in. Dentists are being paid based on their historic earnings so all is well in department-land. However, all is not well for dentists working at the coal face.
The world has changed since the test year. For example, costs associated with the ban on reusable endodontic files and the introduction of the new decontamination requirements HTM 01-05 were never factored into practices’ costs. The fall in the value of sterling also means that expenses have gone up but payment is still based on historical data.
Patient demographic bases are likely to have changed in the interim, and many dentists will have moved on from the positions they held four years ago. Practice profiles also change over time. New dentists have come in and have tried to grow their lists, taking on new National Health Service patients (as the department wants) but are still being paid on a historical basis.
This anomaly results in large differences in UDA value between practices in different parts of the country and in some cases even in the same area. Can it really be justified that one practice earns £32 per UDA, resulting in £96 of funding for a band 2 course of treatment, while another earns only £54 because their UDA value is £18? Even worse is the differential between £384 and £216 for a band 3 course of treatment. How can this be justified?
Is there a solution to the variability of UDA values? Is there someone looking at the clinical datasets returned to the BSA and looking at how many fillings are done per UDA? If those on £30+ per UDA are doing 50 per cent more work than those on £20 per UDA, then surely the higher UDA value is justified. But if not, there is definitely a need for harmonisation of the UDA value to ensure fair treatment for all dentists. But harmonisation must include the driving up of low UDA values as well as high UDA values being brought down and not the universal reduction of all UDA values.
One hope is that when the Steele process is evaluated – albeit this could take at least another two years – that this results in a fairer system for rewarding dentists.