4 Nov 2019  •  Dentistry Confidence Monitor, NHS Dental Landscape  •  11min read

Contract reform: a change for the better?

Nigel Jones and a panel of professionals discuss the state of NHS dentistry and the impact contract reform may have…

It’s less than six months to go before contract reform is due to begin being rolled out.

Since the original timeline of April 2020 was announced last year, there has since been little decisive movement. This has led to feelings of confusion and speculation among many that the date will be pushed back to later in 2020, if not even further.

The lack of action will bring little comfort to the 93% of dentists with NHS involvement who believe it is important for the current NHS contract to change.

That’s according to the 2019 Dentistry Confidence Monitor survey of NHS and private dentists held by Practice Plan.

Despite this widespread desire for change, there is an equally prevalent view that the change that is being proposed through reform will not be a positive one.

Only 4% of dentists with NHS involvement surveyed said they thought the reformed contract would work well for the profession.

To discuss what these results mean for dentists and the future of NHS dentistry, we held a discussion with key leaders within the profession including Eddie Crouch, Bethany Rushworth, Simon Thackeray, Duncan Thomas, Rory O’Connor and Chris Groombridge.

A pig in a ball gown

In a typically colourful analogy, Simon described the reformed contract as a dressed-up pig.

“The NHS contract is a pig,” he said. “If you dress a pig up in a ball gown or tuxedo and call it a new contract, it’s still a pig – and that’s what we’re going to have.

“It might be more attractive initially, but it’s still a pig.”

That paints quite an image, but on a serious note it does encapsulate the feeling many have that contract reform simply won’t be an improvement on the existing contract.

And given that 89% of dentists with NHS involvement are unhappy/very unhappy with the current contract, that does not create a feeling of optimism around the future for NHS dentistry.

The need for action

Eddie said, “Something has got to happen urgently, and there are other ideas in the pipeline such as flexible commissioning or some kind of transitional arrangement that will give some stability back to NHS practices that are on the brink.

“Delaying the introduction of a reformed contract is fine to get it right, as long as something else happens. And something else has to happen because otherwise the whole system will come crumbling down.”

Duncan, who recently removed his practice from the prototype programme, said, “Contract reform is not a panacea.  

“The latest I have heard about the reformed contract is that there will be a move towards a capitated system based upon deprivation and age of the patient.

“The problem with that is that it’s not the system that is being prototyped at the moment.

“So, the drivers behind the contract aren’t being modelled. They might be being modelled at a statistical level by the Government behind the scenes but it’s not what’s driving practices that are delivering the contract through the prototype programme.”

Resilience training for students

The panellists discussed how the uncertainty around the reformed contract and the way it is due to be rolled out is taking place amid a backdrop of dentists working in an increasingly pressurised environment.

They talked about increased expectations from patients, regulatory burdens, the risk of litigation, financial strain and the feeling of needing to do more with less.

Indeed, Eddie highlighted that the pressures are such that some dental students are now receiving resilience training at university.

To which Rory responded, “The need for resilience training is symptomatic of modern-day slavery, because the expectation is that you must give more for less.”

The results of the Dentistry Confidence Monitor survey suggest many feel reform won’t improve that feeling of pressure. The majority of dentists with NHS involvement say they think it will increase their workload and decrease their profitability.

Rory suggested that more ‘togetherness’ among the profession and a united voice would help to drive the positive changes that so many want to see.

“The results of the Dentistry Confidence Monitor survey suggest many feel reform won’t improve that feeling of pressure. The majority of dentists with NHS involvement say they think it will increase their workload and decrease their profitability. “

He said, “Togetherness includes the GDC, the BDA, social media groups and anyone in the profession who has a reasonable voice, to get together and stand together to have enough power to challenge the Government.”

Eddie said, “We have a voice, what we don’t have is ears on the other side.”

The Health Select Committee

There was debate about whether the Health Select Committee’s (HSC) recently opened review of NHS dentistry could be a driver for change.

Chris said, “The HSC in 2008 was damning on the current contract and said it wasn’t fit for purpose. I’m hoping in the current climate where we have a small government majority, that this could make somebody sit up and take notice.

“Personally, I think that only if access is affected will the Government take notice because that is what starts to fill up MP’s postbags.

“But hopefully the HSC will highlight the big issues and say ‘you can’t keep ignoring them anymore, stop trying to bury them’ and then we can have a realistic sensible conversation about finding a solution.”

Bethany added, “It isn’t a priority at the moment for government because their perception is that there’s currently enough dentists to replace those who are unhappy.

“So, despite what we know to be the reality, they’re happy for dentists to leave the NHS or move to private practice because they think they can still provide access to dental care.

“Dentists’ opinions on contract reform won’t really be addressed until it’s too late. While reform probably isn’t in the best interest of dentists it doesn’t seem like anyone cares as long as it’s financially benefitting the Government and patients aren’t noticing an affect to their access to care just yet.”

The survey results suggest that the perception of there being a ready supply of dentists willing to deliver NHS dentistry might be wide of the mark.

“Dentists’ opinions on contract reform won’t really be addressed until it’s too late.”

Seventy-seven per cent of predominantly NHS dentists said they do not see themselves operating in the NHS in five years’ time.

And, only 46% planned on staying in dentistry at all – by moving to private – with the rest indicating they would retire (either as planned or earlier than planned) or change profession entirely.

Anxiety and the diet of fear

Rory said that the desire to leave their job was a common theme among the calls he takes from dentists struggling with their mental health.

He said, “Pretty much everybody starts off saying ‘how can I leave?’

“I always begin the conversation by saying that now is probably not the time to make that decision, they need to look at getting well before they even start to think about things like that.

“The most common presentation of people coming to the service is anxiety, depression and addictive disorders. We can help people understand what that is but behind that is understanding what the trigger is for it and quite often work plays a high part.

“Anxiety is the diet of fear and within that there are menus of rumination and anticipation about what I’ve done and what’s going to happen.

“One of the primary drivers within anxiety in the dentist is the fear of dentistry – what have I done and then you get into over-checking, etc, and then what might I do. Which is why we delay them thinking about leaving the profession because we might be able to help them practise in a different way and address it in a different way.”

The mental health of the profession was a recurring theme throughout the discussion, which may be a reflection of how important the topic is becoming as well as the growing awareness of just how big a challenge it is.

“One of the primary drivers within anxiety in the dentist is the fear of dentistry”

Practice Plan will be sharing more details of that wider discussion, which also included the GDC, the culture of the NHS and mindset of the profession, and the education of dental students, in future articles, blogs and videos.

Dentists who want to learn more about contract reform and the impact it may have on them are invited to attend free panel discussion events, all of which include Eddie.

The What Next for NHS Dentistry? events take place on November 20th in Chelmsford and November 27th in Nottingham.

For more information visit: www.whatnext-nhsdentistry.co.uk

Get all blogs delivered to your inbox

By subscribing to our blog, you agree to receiving our monthly blog update and newsletter. You can unsubscribe at any time. The security of your personal data is very important to us and we will never sell your data to other companies. You can read more about how we protect your information and your rights by reading our privacy notice.