Practice Plan Sales and Marketing Director, Nigel Jones, talks to dentist and BDA Principal executive committee member, Lauren Harrhy, about the government’s’ Dental Recovery Plan.
Nigel: I know that you practise in Wales, Lauren, so you aren’t directly impacted by the Dental Recovery Plan but given all the activity that you are engaged in on behalf of the BDA and its members right the way across the UK, it is interesting to get your take on what you think the dental recovery plan really means. We’ve heard the way the government has positioned it and I’m also familiar with some of the things the BDA has said about it. What’s your perspective?
Lauren: I think the Recovery Plan doesn’t even touch the sides. Essentially, it’s not going to aid recovery back to previous 2006 levels even. We’ve seen a decline in NHS dentistry since the 2006 contract came in and an even more rapid decline since COVID and I think that this recovery plan is woefully inadequate and will not fix any of the problems.
Nigel: What sort of things do you think don’t really stand up to scrutiny?
Lauren: This is not new money. This is money that’s been rehashed from clawbacks. So, there’s no new investment, and there will not be reoccurring investments. The £20,000 payment, per practice will probably be swallowed up by practice costs because we know that costs have been running away with us over the past few years. Whether or not that will translate to more activity, is quite unlikely. We haven’t been shown the modelling on this and it’s a one-off cost. So, it doesn’t mean that every year there’ll be that level of investment into the practices. So, it might be okay for the very short term, but it’s likely to not translate to anything new going forward.
Nigel: There was a change in the minimum UDA value. However, my understanding is that it’s not going to benefit that many practices.
Lauren: No, it won’t. We wanted the minimum UDA value to be brought up to a safe level. We believe that below a certain level it’s not actually safe to be trying to run the contract. It will only just benefit the practices that were sitting below a certain level. It will only nudge them up to just above, or nearer to that average level that we believe they should be at.
Nigel: I saw somewhere that about one in 10 practices are likely to benefit from that. And of course, there’s the whole issue about what needs to be passed on to associate dentists. Picking up the point you made about rising costs, the scarcity of associate dentists is driving up the cost of employing associates. So even though the UDA value will have gone up a little bit, just how much it will benefit the practice, is open to debate.
Lauren: Yes, absolutely. Also, the costs for employing nurses, receptionists, and so on will all be going up as minimum wages rise. So, those practices that were sort of skating along the bottom near the edges of affordability, will still have all those problems because any injection of money into the practice, is likely to be swallowed up by rising material costs, rising lab costs, and rising staffing costs.
Nigel: Something also included in the plan was the new patient premium. Does the BDA sense that it will achieve its objective?
Lauren: I think that the problem we’ll see there is that practices who are currently working at capacity, or unable to meet the demands they are currently under, will find that they may offer appointments to new patients, but that will mean that other patients will have to be displaced because there aren’t enough dentists to do the work. I think practices will try hard to expand capacity, but will find it difficult to do so.
Nigel: This is a key part of this. There just aren’t enough dentists willing to work within the system and that has to be a major factor behind relatively large levels of clawback. Last year there was about a £400m or £500m underspend and it looks like we’re set to see something fairly similar for the year that’s just about to come to an end. That, in part, is because there just aren’t enough dentists willing to undertake the activity.
Lauren: Absolutely. The clawback levels would’ve looked worse last year had they not changed the goalposts. So instead of taking it at 95%, they took it at 90%. Realistically practices are not able to fill positions, and they’re not able to achieve targets in the way that they used to for a number of reasons. We are seeing a lack of clinicians, not just dentists, but part of the recovery plan seems to be reliant upon skill mix with therapists working to their full scope of practise and lots don’t. They don’t want that responsibility or haven’t felt supported to be able to do that until this point. And there aren’t that many therapists out there. We need lots of clinicians to be able to deliver these high levels of activity and there isn’t anybody willing to come back into NHS dentistry to be able to perform that.
Nigel: When you look at the NHS long-term workforce plan and its ambitions to increase the number of hygienists and therapists as well as dentists, we’re talking the end of this decade and into the beginning of the next before there’s anything like a reasonable number that are qualifying. That’s a long time for NHS dentistry to try to survive. It’s hard to see how they can turn that around. But I know they’ve been talking a lot about overseas dentists; do you think that will make a big difference?
Lauren: There’s some controversy about removing or reducing the importance of the ORE (Overseas Registration Exam. We are concerned that might become more relaxed because at present, less than 50% of dentists who sit their exam are able to pass it. We need to be wary, as we’ve got practices that are vicariously liable for these clinicians. Whatever government and the GDC say about supervision, it places a burden upon the practices in which these dentists are working while they’re being temporarily registered.
So, while I agree that we could benefit from an influx of fully qualified dentists, we’ve got to introduce them with caution because we have patients and practices that could suffer as a result of just opening the flood gates. Even if that were to go smoothly, regardless of any other concerns about it, why would any dentist want to come and work in a system that UK dentists haven’t been able to make work? We might see overseas dentists coming in and perhaps being handcuffed or coerced into NHS contracts and staying for a little while. But why would they stay? Why would they patch up that leaky bucket any more than UK graduates would?
Nigel: Lauren, thank you so much for your time. I really appreciate getting your views and your insights and your sense of what’s happening at the moment.
About Lauren
Lauren Harrhy is Principal Dentist and owner of Sparkle Dental Centre. Her focus for the past few years has been on helping to maintain the mental health of dental professionals. She is a founding member and current trustee of Confidental, a helpline providing emotional first aid and signposting to dentists in crisis. In addition to Co- chairing its Equality, Diversity and Inclusion Committee, she is also on various other BDA committees as a representative.