21 Jun 2013  •  Options Out Of The NHS  •  3min read

Mild Expectations – Thoughts On The New NHS Contracts

Nigel Jones, Sales Director at Practice Plan, takes some time to share what he would like to see from the new NHS contract.

The challenge of coming up with a new contract for NHS dentistry is multi-faceted and there are many agendas to consider. Different stakeholders have different objectives and, what is one group’s failure is another group’s success. Balancing patient care, professional sensitivities, politics and financial/budgetary considerations is reminiscent of the familiar comparison with a Rubik’s Cube – in the process of resolving one set of issues, you can, inadvertently, create a second or third set.

The forthcoming version will no doubt seek to address the well documented shortcomings of the present version, and will no doubt create a whole new set of issues in the process. Of course there is an appeal to a contract based largely on capitation in which there is the perception of freedom to deliver what is the most appropriate care for the patient, not the contract. However, a key consideration will be how adequately the contract is funded as underfunded capitation creates very real pressures. Along with that, productivity concerns will mean a whole raft of potentially time-consuming controls will need to be in place to provide comfort that, to coin a phrase, the taxpayer is getting value for money.

Ultimately though, this is akin, not to rearranging the deckchairs on the HMS National Health Service but, as the icebergs of an ageing population, increased obesity, long-term conditions, etc. loom, to prioritising the decision about what colour to paint them.

If that sounds like some trite throwaway observation just to look clever in an article, it’s not meant to be. I’m exceedingly concerned at what the next few decades will mean in terms of the demand for healthcare and our ability, as a country, to afford it.

Given how long these icebergs have been on the horizon, it will be to the eternal shame of successive Governments that they lacked the courage to take the evasive action needed. It’s not that I underestimate the scale of the challenge. Having worked for a time within wider primary and secondary care, I’ve come to understand just how incredibly complex our National Health Service has become. However, something needs to happen fast and that complexity can be an excuse for procrastination; so in an ideal world, I would like to see them simplify the problem marginally by taking this opportunity to move dentistry to a core service, focused on the most vulnerable.

Of course, that’s never going to happen. It’s not just dental payment systems that have perverse incentives with our political system encouraging the short-term pursuit of re-election ahead of what’s right for the country in the long-term.

Therefore, the most that I can hope for is a contract that meets the political needs of the Government to avoid being painted as destroying the NHS, that meets the financial needs of the Government to be affordable in the context of our economic woes and gives the impetus to the dental profession to help the Government simplify its wider challenge by moving their practices towards a core service.

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