30 Oct 2015  •  Blog, NHS  •  4min read

Rubik’s NHS Blog – No.5

In this final instalment of blogs highlighting the unintended consequences of efforts to improve the NHS dental contract in England, the Rubik’s Cube effect, I want to touch on the thorny subject of when and what private care can be provided to NHS patients.

The lack of clarity about this issue has been the cause of significant debate since the inception of the current contract and even as I write, there is a lengthening thread about it on GDPUK.

The topic received considerable coverage at the start of this year with a report by Which? that demanded that the Competition and Markets Authority force dentists to provide greater clarity and transparency over costs. A specific request was that dentists explain all treatment options to patients and make sure their patients know if the treatment is NHS or private.

It’s pretty hard to argue with such an apparently simple request but beneath it lies a lot of complexity and soul searching for many dental practitioners. For a start, it opens up a discussion about the relative benefits of private care versus that which is available on the NHS and with that comes the risk of contractual breaches.

Many dentists seem comfortable with the headlines in this respect but can struggle with the detail when it comes to patient entitlements and I’ve heard it said that this leads to dentists playing it safe and not discussing private options with patients for fear of getting it wrong.

Against that backdrop, a call for a simpler contract with greater clarity and transparency seems to make a lot of sense and is potentially a win-win for all concerned.

However, the fear is that improved clarity coupled with the contractual requirement that there should be no difference in health benefits/outcomes between NHS and private care, will make it more difficult for the benefits of private treatment to be articulated. This in turn is likely to lead to a reduction in the take up of private treatment options in NHS practices, with the consequent reduction in private income and, in some cases, some important cross subsidy of NHS care.

I was in an NHS practice recently that, if it wasn’t for the blue and white NHS branding visible everywhere, could easily be mistaken for a private practice. That’s not entirely uncommon although this practice was slightly unusual given its location on the edge of a council estate with high levels of social deprivation. The high level of care provided to patients was truly impressive and would compete with that found in some of the most patient focussed of private practices.

Despite the patient demographics and the location, a core revenue stream for this practice, fundamental to its financial viability, has been private income of which the take up of private hygiene services plays a significant part. Without this income, the owner is certain that the practice could not continue to offer the high quality of care it provides under the NHS and may even struggle to survive.

However, so far as I can tell, the practice is sailing very close to the wind when it comes to promoting the private hygiene service to NHS patients and greater patient clarity around the quality of care the dentist is technically contracted to provide under the NHS could have a massive impact.

At one level, this is of course entirely appropriate but is it as simple as that when it could ultimately lead to a degradation of the overall NHS care provided by the practice or even its removal through the closure of the practice?

It certainly appears to an outside observer like me that this is not an outcome the LAT wants to risk, which is justifiably proud to have such a wonderful practice operating in such a difficult area.

This is not an isolated example and so an apparently reasonable and straightforward request for greater clarity and transparency within the new contract could have some profound ramifications for the viability of many NHS practices.

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