24 Jul 2019  •  Future of Dentistry, NHS Dental Landscape  •  6min read

NHS dental contract reform – three big questions

Changes to the NHS dental contract in England will start being rolled out from April 2020. From previous contract reform it’s clear that this will have big ramifications for dentists working within it and dentistry as a whole.

To discuss what these might be, I spoke to Simon Thackeray a practising dentist who moved from NHS to private, member of the BDA’s General Dental Practice Committee and an expert witness…

Nigel Jones (NJ): What are your thoughts about how well the contract reform prototype programme has been working?

Simon Thackeray (ST): It’s working well for the Government but for practices involved it doesn’t seem to be working brilliantly because their profitability is going down.

Blend A prototypes (where band one is paid for by capitation and bands two and three are paid for by activity) are struggling to hit the targets more so than blend B (where band one and two is paid for by capitation and band three by activity).

But they’re both still experiencing NHS dental contract clawback and having to find space for increased numbers of patients.

Under the reformed contract you now have to see more patients simply to stand still; you could actually have more patients than the previous year, do more treatment and still not hit the target because you’re seeing the wrong kinds of patients now.

“Many practices that are meeting the targets say they have to invest in more staff to do so. But if you’re doing that in a fixed price contract, it will affect your profits negatively.”

Many practices that are meeting the targets say they have to invest in more staff to do so. But if you’re doing that in a fixed price contract, it will affect your profits negatively.

It’s ironic that the practitioners who say they are making it work are doing so by increasing the amount of private work to subsidise their NHS delivery. Why subsidise the loss-making part of your business? Why not just make a profit?

When the reformed contract is rolled out, it could be an option that you’re able to choose blend A, B or stay where you are. If you are offering a set of options that includes one that is currently so bad that you want a new contract (but that might be the option you have to take), that doesn’t say a lot for how good the other two options (A and B) are.

That’s like choosing just how do you want to be executed: a bullet, an axe or a lethal injection?

NJ: If the contract which is rolled out from April 2020 is that kind of choice, as you vividly put it, what are the implications of that?

ST: It probably won’t be rolled out en-masse, it will probably be gradual. Hopefully people will watch what happens in the beginning, see how it goes and make an informed choice from there.

I think there will be an increase in people moving to private dentistry or wanting a bigger percentage of practice income to come from private dentistry. Then we are getting into the area of what level of mixing NHS and private will be allowed under the new NHS contract. And if it’s as wishy-washy as the current one, there will still be the same level of ambiguity about what options are available to patients.

NJ: What does all this mean for NHS dentistry in the long-term?

ST: The difficulty is that when it comes to funding for the NHS, dentistry is not as emotive as children’s cancer care. Even as a dentist you find yourself thinking, ‘should we be putting money into dentistry when there are these other areas that also need funding?’ Although dentistry is important, we do need some perspective on what we actually do.

I think NHS dentistry could be reaching its terminal phase and won’t need many more dentists to move out of it before it reaches the end.

And those who do stay won’t see any more money. Clawback is already lost into the vapour as it is, possibly spent on life-changing – and some might say better – things within the wider NHS. 

“I think NHS dentistry could be reaching its terminal phase and won’t need many more dentists to move out of it before it reaches the end.”

This raises the question of whether a core service could replace the current system. But there wouldn’t be the same money for a core service. The BDA has said before that a core service shouldn’t mean core funding, but it will.

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