7 Jul 2021  •  Covid-19  •  6min read By  • Hussein Hassanali

The Covid-19 Chronicles: an associate’s view #8 – Hussein Hassanali

For the last 12 months, Hussein Hassanali has been blogging about life in the dental world during the pandemic. Throughout his series of blogs, he has described the challenges of working through Covid and, in this latest post, he talks about the rise in UDA targets and the strain on NHS dentistry…


Lockdown part three has passed; social restrictions are winding down. Sequels are generally worse than the originals, this lockdown being no exception. The winter dragged on into a rainy spring. Uncertainty, both inside and out of the dental setting, has had quite an impact on providers and performers.


The honeymoon period of 2020 targets had to end sometime. Just when there was breathing space, we’re asked for 45% in Q4 and combined 60% in Q1 and Q2. It’s been decided that the “pile ‘em in” approach endures as the best way to meet patient needs. Happy New Year!


NHS dentistry is an infinitesimal proportion of the overall health budget. As expected, the annual (albeit delayed) above-inflation price hike came just in time for the increased patient flow. Once again, patients are having to fork out even more. Once again, more practice contracts slip behind the patient charge revenue.


There was a below-inflation uplift in contract value. In the decade that I’ve been an associate, I’ve never had any personal raise. Practice owners have felt the pinch more and more the longer inadequate uplifts persist. I don’t expect to ever see any uplift passed down to any associates or have any raise offered to me.


Some NHS practices may be lucky to have a UDA value decent enough to match independent/low-level private prices. Otherwise, the precedent towards increasing the private mix goes on. As before, practices still have to continue subsidising their NHS lists with private choices.


It would have been nice to have had more than a few days’ notice when announcing our UDA targets. As per our June reopening, the practices providing the service always seem to be the last to know what’s actually going on. This led to frantic rushes for planning to meet the percentages.


We started off with child exams from January, while continuing to see patients for urgent and non-urgent care as before. It’s mostly the patients returning for AGP treatments that are taking up diary space because of the required 30-minute fallow period after each appointment.


Our practice had over 4000 children to work through. Somehow, we managed to get through the vast majority by mid-March. Since then, we’ve started with adult recalls. However, undiagnosed and asymptomatic dental diseases seem to be clogging up how efficiently we can keep the ball rolling to fit in the required treatment while seeing reattending recalls.


Hitherto, the algorithms aren’t able to fathom why the incidence of dental disease increases. All dentists want optimal oral health for their patients, ideally unrestored with no periodontal disease. Instead of rewarding preventive performance with recalculated stats, the analytics only want to catch anomalies, outliers or underperformers in their crosshairs.


For patients declared dentally fit following their exam, they aren’t getting the full band one range when it’s nigh on impossible to do ultrasonic scales with fallow times involved, which leaves patients questioning why they came. The only way an ultrasonic scale is realistically possible is if it’s coupled with other AGP treatment or self-referring for private hygiene.


When trying to get a five-figure number of adults back to optimal dental health, our practice needs to plan carefully. There’s no point in jamming all the exams in then leaving no space for treatment and keeping patients waiting to complete any planned treatment.


There is always a threat of sanctions for any target, no matter how high or low that target is. The powers that be act with omnipotence, fully believing in their benevolence, while the omnipresent threat of clawback hangs over all NHS dentists like a dark cloud.


One must keep on questioning whether measured activity is still the right way forward for the NHS. It appears that the most satisfied dentists are those whose practices are heavily biased towards the capitation or plan models. As an associate, could I be better off in the private sector in all areas – clinically, financially and personally?


This could have been a time for change for NHS dentistry, to develop a system that dentists enjoy being in rather than desperate to leave. A system promoting prevention as the long-term future to create healthier oral cavities for generations to come. Appropriately rewarded multiskilled teams working to their full scopes of practise.


If the NHS wants to attract and keep dentists and DCPs in its ranks, it needs clinical satisfaction coupled with annual wage rises for all workers in the system. Whatever it is, this goes to show how complex the dilemma is to solve.


As the Covid-19 pandemic comes to a close, the demands on the NHS as a whole are greater than ever. Record lengths of waiting lists for surgery, dentistry, referrals and just about everything continue to put the service under immense strain.


It took 358 years to find a proof for Fermat’s Last Theorem. Anyone want to join the sweepstake for how long it might take them to solve NHS dentistry?


About Hussein Hassanali


Hussein graduated from the University of Liverpool in 2009 and completed his PG Dip in Restorative Dentistry in 2020 which granted Fellowship of BAARID. He is an NHS Associate Dentist in York with a special interest in ultrasonic restorative dentistry. He has a broad range of experience, having worked in both NHS and private, and both corporate and independent practices. To date, he has over 20 publications to his name, and continues to support the profession through his regular contributions, as well as being on the BDJ Reader Panel and an Editorial Advisory Board Member of Young Dentist Magazine.

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