Nigel Jones talks to Eddie Crouch, Vice-Chair of the BDA Principal Executive Committee (PEC), about the current arrangement for NHS dentists in England, how activity is being measured and what indications there are about NHS England’s future commitment…
Nigel: What have you been working on since we went into lockdown and how have the past few months been for you?
Eddie: It’s been an incredibly stressful time for everyone. During lockdown I had COVID-19 and tested positive afterwards for the antibodies, and at the time I was working 14-hour days doing a huge amount of committee work for the BDA and media appearances. So, I was slightly glad when we actually got back to a situation where we could see patients.
Some of the conversations I’ve had with members of the profession and colleagues have been quite distressing in terms of the huge amount of stress many people have been under.
Social media has been quite an interesting place during this period of time. There’s been plenty of people who are sadly under stress and they’ve been reacting in a way that’s been quite worrying really, and I’ve been subject to quite a lot of things, as well as the plaudits.
These times do generate people reacting in strange ways, but I understand that because people are seeing their businesses as really vulnerable.
Nigel: Absolutely. And I would say a personal thank you on my behalf and on that of many of the clients that we work with, because the BDA website has been an absolutely invaluable source of information. Which leads me on to another question: what is the latest on the hacking of the BDA website?
Eddie: Thankfully, we’ve managed to recruit some real specialists to help us and we’ve now got the website up and running again. It has been a real void; many people chose that as the go-to website for reliable information, and we opened it up to the whole of the profession, which was really welcomed by everyone.
It was really upsetting for my IT colleagues at the BDA that this has happened. They take it very personally and they worked flat out to try to get the service back up and running.
Nigel: You must have been really pleased and proud with the result of a lot of hard work from the BDA in terms of the current arrangements for an NHS dentist in England?
Eddie: I think Dave Cottam and his two Vice-Chairs, Shawn Charlwood and Vijay Sudra, have been really quite steadfast. It’s been quite difficult because at many points along the way, they’d got to a point where they thought that they reached an agreement with NHS England on the arrangements, only for those agreements to be taken back up through the structure of NHS England. This is really something that needs looking at after this pandemic is over, because it doesn’t operate very well for dentistry.
The communication channels have been terrible. We’ve been getting letters that are five or six days out of date, sometimes even longer, because someone higher up the chain in NHS England has been waiting to sign it off. And of course, the worrying thing is that it took so long and it gave so much uncertainty to people out there that this deal took almost three months to negotiate. And we were only negotiating a period for the next three months.
If it takes so long to negotiate such a rescue package as we’ve got at the moment, it doesn’t fill me with confidence about how we go forward negotiating bigger terms of a contract. It indicates to me that NHS England are serious about supporting NHS practice because, as you rightly say, this is a supportive package that we’ve managed to get.
Nigel: I was very impressed with what the BDA were able to get because it does look really supportive. What made NHS England go for that and what could that tell us about their future commitment?
Eddie: If we look at what was happening pre-COVID-19, access to NHS dentistry has been on the agenda for a long time. And many practices are supported not only by NHS income, but by private income as well – there is definite cross subsidy. Whilst we’ve been able to secure the NHS income, unless we can do more to support the private income of some practices, it still makes NHS services vulnerable.
But I do suspect that NHS England is keen to support NHS delivery and for those who have a majority delivery of NHS care, this is very supportive. However, for the many practices who have a mix, without the private income coming in to prop up the NHS provision, we are in vulnerable times.
Jason Wong, who’s recently been appointed as the Deputy CDO, has got a taskforce together to look at what support could be given to mixed practices. I’ve seen an early draft of that report, which I think NASDAL, the BDA and the BAPD have been involved with, which is quite encouraging.
If Jason’s report lands on the Chancellor’s desk, I hope it has more impact than the 101 MP letter that we managed to secure going to the Chancellor to try to get support for private practice or private elements of practice, which sadly has fallen on deaf ears.
There’s a huge wave of the population that get their treatment from private delivery and it doesn’t make any sense to me that you wouldn’t want to support that delivery of service. Because if you don’t support it in the short term, then in the longer term you’re going to have a population that’s relying on an NHS service that might cost you additional money.
I would suggest to the Chancellor that by supporting private delivery at this present time, he would save money in the long run. It’s almost like prevention, in that you spend it now to prevent the collapse of the service out there.
Nigel: Returning back to the details of the current contractual arrangements, there’s been a lot of discussion about the fact that we’ve moved away from UDAs onto another activity measure. But there seems to be some confusion as to exactly what would be measured and how people would know how they were doing. What’s the latest position on that?
Eddie: From the letter of preparedness that came out, it’s clear that the practices should continue to triage patients so they are seen on a face-to-face basis, even if that’s only to check on any COVID-19 status within the household. And that still needs to be recorded on Compass.
There is some work with the software suppliers to integrate it more with current systems and make it easier for people to use. Putting all that triage onto Compass is quite a clunky arrangement and that’s been quite difficult and time consuming for a lot of practices.
Hopefully that will improve, but that will be included in the activity measures and it’s important that people don’t overlook that. And of course, we’re not talking about UDA delivery during the three months that’s being looked at, we’re talking about courses of treatment.
If you are getting people in and temporising things and doing emergency courses of treatments, you need to be sure that that’s submitted, even if the long-term plan for that patient is such that you will need to do a full course of treatment in due course.
Nigel: Eddie, thank you for taking the time to share what’s been going on and what we can expect for the future.
Watch the full interview, where Eddie and Nigel further discuss fallow time, the treatment and payment of associates and whether there will be a return to the UDA system, here.
*This interview took place on 12th August.
Nigel was speaking to Eddie as part of our ‘Inside Out: NHS Dentistry Discussed’ series. The next of these interviews will be with Martin Woodrow, Chief Executive of the BDA, on Thursday 3rd September. Book your free place here.