The 2006 dental contract has been deemed a failure in the eyes of many current National Health Service dentists. The demands of the high needs patient and the rigidity of the system – making it very difficult to expand – are just two of the reasons why it is disliked. Recent changes in contracts being offered up and down the country, in the form of PDS plus, have also been criticised. The UDAs stay, but payment is now also attached to patient access targets and key performance indicators (KPIs)
For many in the profession, the review undertaken by Prof Jimmy Steele in his July 2009 Review of NHS dental services in England was seen as a bright light in the often derided NHS dental services. Many hoped that was to be the way forward.
It has now been 12 months since the release of the report and the dentist at the coalface is still looking for changes whilst forced to deal with the UDA system. The Government has changed but as yet the old policies appear still to be in place.
First wave Steele pilots have begun, but the expression of interest forms indicate that they were only grouping together a set of practices who were already lucky enough to have a PCT willing to fund them on something more than UDAs. The first wave pilots did not help the average practice working for an average PCT where UDAs are first and last on the monitoring menu.
Wave two pilots appear to embrace most practices out there who want to trial a different way of working: 568 expressions of interest shows many would like to know more. Their reasons will vary, but I expect many are hoping that if they get in early they will be rewarded for their proactive stance. Previous early adopters of new NHS systems did very well from their enquiries. Early PDS pilot practices (before 2006) were able to secure guaranteed funding without monitoring of their output. Their early adopter stance allowed them to take their foot off the pedal and provide a different service to their patients whilst GDS practices were working under item of service regulations. Even when the old PDS system was pulled in favour of nGDS, their early adoption of the pilot contracts gave them, on the whole, higher UDA values than their neighbouring nGDS practices. Overall they were well rewarded for piloting new reforms.
But this time round, the pilot practices appear to have no safety net with regards to guaranteed funding. If the pilots have unintended negative consequences, the risk lies with the practice. A comprehensive oral health assessment appears to be a central theme to the Steele review, but this takes time – especially for new patients with high treatment needs. However there is no new central funding for this. If it takes more time to work in this way and there is no more funding, then output will have to drop. The last time this happened with PDS, the Government put a stop to it and brought in UDAs. What will happen this time?
New monitoring methods are to be brought in to substitute for UDAs. Known as ‘quality indicators’, they have eerie similarities to KPIs in the PDS plus contract. Measurements of access and patient satisfaction scores are here as they are in the PDS plus contracts. Do they really measure the outcomes that Prof Steele mentioned in his report? They appear like another tick-box exercise that can be easily spun by the Government to 'prove' their new reforms are working.
I fear that the control that was placed over practices in 2006 with the nGDS contract will continue in whatever form of contract comes in to replace it. PDS plus took the level of control and intrusion to another level and the Steele reforms may be going in the same direction.
However, with a new Government in place, will these reforms still go ahead? Before the election, Mike Penning, the shadow health minister in charge of dentistry, made noises against the Steele review process. Earl Howe has now taken over that brief in Government and has promised a review of the current system but we will have to see whether he will sanction the continuing of the Steele process. Either way, I suspect that that the level of control that PCTs were given over practices in 2006 will not be going away any time soon.