24 Aug 2019  •  Blog, NHS  •  5min read

What does the future look like for an associate NHS dentist?

All dentists are likely to face changes in their targets.

This is both in terms of the numbers of patients they need to have on their list (capitation) and the amount of treatment they need to carry out (activity).

This is due to the reformed NHS dental contract which is due to be rolled out in April 2020 – although there is speculation this will be pushed back to a later date.

If the practice you are working in chooses to take one of the reformed contracts on offer – which is a possibility, given the amount of frustration there is towards the existing contract – this could affect you as an associate in terms of changing how you work.

Of course, there is the chance your practice will decide it’s a case of ‘better the devil you know’ and stick with their existing UDA contract. Currently, the understanding is that dentists will be given a choice of whether to go into a reformed contract or stay as they are.

However, even if that is the case, some believe that eventually, as the reformed contract is rolled out across England and more practices move under it, it will reach a critical mass and those who stayed with the current contract will have to transfer over as well.

 So, should you find yourself working under a reformed contract, what does that mean for your future?

Different targets

It is expected that when the reformed contract is rolled out, there will be a choice of two contracts. The Blend A and Blend B contracts have been tested by pilot and then prototype practices over several years.

The difference between the two is that remuneration under Blend B is more weighted towards capitation. Here’s a more detailed explanation from the BDA.

At an event for NHS dentists recently, one former owner of a prototype B practice said one of the biggest changes for his associates had been refocussing their attention on growing the patient list. There was an incentive to take on more patients as that meant a reduced number of UDAs, and more time for prevention-focused treatment.

A new care pathway

Under a reformed contract, regardless of blend, treatment is delivered via a care pathway. This has been fairly unanimously agreed to be a positive thing.

Patients have an Oral Health Assessment (OHA) and are given a RAG (Red, Amber or Green) score for their oral health. Those who are given green statuses are likely to have longer recalls, than those who receive red.

Dentists who have already been using the care pathway have said, in general, that they saw an improvement in patient’s oral health and in their motivation to look after their teeth.

More utilisation of DCPs

In discussions with dentists who have been involved with testing the new contract, there is often talk about how they ‘make it work’.

One of the ways in which they do this is by using a wider mix of skills within the team. This can mean therapists and hygienists delivering treatment that has traditionally been carried out by associates.

So, this may require a new way of thinking about the different roles and responsibilities within the practice, and a need to adapt accordingly.

Mixing of income

Many dentists involved in the reformed contract have also discussed how they have changed the mix of NHS and private treatments to keep the business sustainable.

They have reported an increase in their private income, and a recurring message has been the prudency of not being solely financially reliant on the NHS.

Associates, along with practice owners, principal dentists and DCPs, have been attending What Next for NHS Dentistry? events to find out more about what the future holds for them. 

At these free events, audience members can listen to, and ask questions of, a panel of experts including those involved with the contract reform process.

Four have been held so far across the country, and more will be coming soon in the autumn.

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