Contract reform: Half-measures risk sustainability of NHS dentistry

The evaluation report catalogues progress on work since 2016 to prototype an updated model for the widely discredited English NHS dental contract, revealing potentially fatal flaws in the proposed business model. 

One in four of the hand-picked prototype practices have been unable to hit the access and activity targets, with the average practice reporting the need to work up to 10 extra hours a month to deliver on their contract.

The current contract, in operation since 2006, has fuelled patient access and staff recruitment and retention issues in a growing number of areas. Over half of young NHS dentists have indicated they plan to turn away from NHS dentistry in the next five years, with 42 per cent stating intentions to move into private practice.

The BDA agrees with the acknowledgement in the report that the business model needs further significant examination, and said failure to make a sufficient break from the ‘tick box and targets’ model of care could now jeopardise needed change.

The government has pledged to reform the system in successive manifestos since 2010. Dentist leaders have called for the current reform package to be refocused away from activity targets and towards improving health outcomes, for significant expansion in the number of practices testing a new contract model, and for funding to be appropriately weighted towards high needs patients in areas of high deprivation, who routinely require more time-consuming treatment.

The BDA’s chair of general dental practice, Henrik Overgaard-Nielsen, said, “The NHS dental system is fundamentally broken. This report underlines why it will take more than tinkering round the edges to avoid putting NHS dentistry out of business. It makes many sensible recommendations for the reform process, the government simply needs to pull its finger out and follow them through.

“A new preventive model of care is making real headway, but when one in four cutting-edge practices cannot make the grade ministers must go further. We have practices working on their own time to make reform work, but we cannot expect goodwill or charity to form the foundation for our health service. 

“The government’s unwillingness to let go of targets now risks failing patients, particularly those with high needs who require care and attention the current NHS contract was never designed for. We all want to maintain access, spend more time with patients and improve their oral health, but these goals cannot be delivered against the clock and on the cheap.

“We cannot go on as we are. Policymakers must now ensure NHS patients are not left stuck between a rock and a hard place when they require dental care.”