regulation, regulation, regulation!

There is little doubt that HTM01.05 is probably one of the most impactful documents in the whole history of English dentistry. Released just before Christmas it sets out two levels of standards for the areas of decontamination and cross-infection control within dental practices: “essential” and “best practice”. The “essential” standard is to be in place within twelve months of the release date of the document, and “best practice” is, for the time being, saved for another day.

I am sure that many practices already comply with most, if not all aspects of the “essential” standard, apart from one which is the need to produce a detailed plan as to how “best practice” will be implemented. For some practices this could prove the final straw, as apart from the cost of complying with this level, which in terms of capital expenditure alone is a minimum spend of about £20,000, some may just not have the physical space required. In this situation a practice might have to consider a number of painful and expensive options including; building an extension, re-locating, decommissioning a surgery room, selling the practice or, worse, just closing it!

Then, there are the extra revenue costs such as maintenance contracts on washer-disinfectors and autoclaves, the fact that some instruments will have a shorter life and higher repair costs due to the increased cycle times and, for larger practices, extra staff may well be required.

Add to this the cost of registering with the Care Quality Commission (CQC) with effect from April 2011, and you have a tidy addition to the cost base. So, now for some questions. What level of grants will be available to help practices to cope with implementing the “best practice” standard when it arrives? If you allow an average spend of £25,000 per practice, given that larger practices will need more equipment and instruments, and say that there are about 9,500 practices then you have a total spend in the order of £237.5 million or about 11% of the entire GDS budget. Perhaps generous grants will be made available, but against a backdrop of severely strained public finances and savage public expenditure cuts predicted, it seems extremely unlikely.

Also unlikely, is an increase in the UDA value to take account of these changes which are likely to add a minimum of about £8,000 p.a. to the cost base of a practice once leases on the capital expenditure and all the revenue costs are totalled (excluding any increased staffing costs) and that also excludes all CQC costs.

It is little wonder that some practice owners are talking of charging associates a fixed “regulatory compliance fee” as costs in this area are set to rise steeply.

So, what next to look forward to? Well, there is always re-validation scheduled to be introduced in 2012!

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