It’s the time of the year when there are lots of festive parties and dental practices up and down the country are full of seasonal cheer. You may be familiar with the custom of ‘secret Santa’, which usually involves the exchange of low cost gifts, this is usually a jovial game and the gifts are usually light hearted. You may wonder what sort of gifts dental commissioners have in store for NHS providers this year…
It is usually at this time of the year that commissioners often start allocating additional resources to providers. Historically there have been different approaches to making such allocations around the country where some commissioners make allocations based on existing contract values and others use average rates, some commissioners will stipulate completion of additional UDAs within this financial year whereas others will exercise discretion recognising the benefits to a more flexible approach. However this inconsistency across NHS England was supposed to disappear with the abolition of PCTs.
NHS dentistry continues to face the demands of delivering a public service in the face of public sector funding constraints. It’s unlikely that most NHS general dental providers will have been issued with any capital funding to invest in equipment or estates.
NHS dental practices continue to try and operate efficiently in the face of rising cost pressures. It would be hoped that commissioners recognise the challenges faced by NHS dentists and that they work with providers to achieve solutions. The NHS has changed in the last 10 years and some of this change can be seen in the rest of healthcare where sustainable change seems to be driven through effective partnership working, where providers and commissioners jointly create solutions. This approach recognises that both parties need each other and that solutions are rarely unilateral.
Christmas is a difficult time within healthcare as we have to carefully balance the needs of our patients with the needs of our staff. Dental practices have evolved from small family practices built in communities. Most dental practices are not large corporate entities with an army of staff but are mostly made up of small teams who are part of the local community. In the past NHS dental providers assessed their own local circumstances and the needs of the communities they served when determining opening hours. Groups of local dentists would coordinate opening hours over holiday periods such as Christmas and Easter, reflecting the relatively lower patient demands during these periods. General dental practice and general medical practice were similar in this regard, however NHS medical practices are still permitted to ‘deputise’ or subcontract their opening hours to another provider with little or no interference from NHS England.
A number of NHS dental providers around the country have recently received a letter from NHS England suggesting that they cannot ‘deputise’ over the coming holiday season and that they must maintain normal opening hours. This is a rather strange move by NHS England as not only is the message inconsistent between area teams but it also seems to fail to recognise the historic nature of deputising arrangements. In fact, the 2005 NHS general dental contract does explicitly permit sub-contracting provided certain conditions are met that are set out in the contract. The sub-contracting aspect of the contract is one of the few clauses that is effective without the need for both provider and commissioner to put the arrangement in writing or to sign. It does however require the provider to inform the commissioner as soon as is reasonably practical but this is different to seeking permission.
Whether this was a planned communication to practices or a reaction from a few commissioners, it does seem poorly thought through and will probably inflame providers that are already under considerable operational pressure.
In my view, the recent communication to practices from NHS England about Christmas opening hours marks yet another lack of recognition of how NHS dental practices operate. The approach from some parts of NHS England seem inconsistent with the principles of the NHS contract, designed to add stress and bureaucracy with little or no benefit to the population.