26 Apr 2022  •  Blog, Future of Dentistry  •  4min read By  • Nigel Jones

The trickle that could soon become a flood – reflections on the new NHS England targets

Practice Plan Group’s Sales and Marketing Director, Nigel Jones, reflects on the recent letter to dentists in England outlining the new NHS targets and considers the implications.

‘Probably the first thing to mention about the letter from the Department of Health and Social Care sent to dentists was the timing of it. That’s drawn criticism from right across the profession, because it appears to show a lack of empathy for the fact that people aren’t only dentists, they’re running small businesses that require a level of organisation and have a number of operational challenges.

To be given information about what activity targets they’re expected to reach, several days into the period of time they’re being measured against, seems, to a lot of people, to be lacking respect. The additional stress caused by the delay is also unhelpful, particularly for a profession that’s already feeling under pressure.

‘Turning to the content of the letter itself; effectively lowering the activity target to 95% when it had originally been positioned as rising to 100%, may be seen as a concession. However, various people have commented that’s not really the way they see it. In fact, the owner of a very large NHS practice with a large NHS contract said that, in his opinion, it works out at 101% due to the bank holidays that are prevalent in the first quarter of this new contractual year. So, to many it isn’t quite the giving that it initially sounds.

‘Also, COVID is still very much with us, and infections remain at high levels. We know from some of the information available that slightly less than half of practices didn’t make the 85% threshold. With infections still rampant, how realistic is it to expect most practices to make 95%? I must admit I’m unsure.

‘The DHSC points to the fact that a number of practices have overachieved against their contracted activity and achieved 100% plus. However, some detail is lacking about which practices have managed to do that. There are many practices that took their adult patients out of the NHS in 2006 but retained a small contract for children. If it’s a fairly big practice, then overachieving against a relatively small contract value may not be that difficult, or challenging.

‘I understand there are also certain things in the letter that needed to be clarified. Such as whether any shortfall within this first quarter can be made up over the remainder of the year. That isn’t explicitly mentioned. It does seem unfortunate that NHS England didn’t run the letter past the BDA, to anticipate some of the questions that have arisen. Maybe some amends to the letter could have nipped these questions in the bud, but that’s not where we’re at and, again, doesn’t help people’s stress levels.

‘One area missing from the letter was any detail about changes to the NHS England dental contract. We’ve been promised quick wins and longer-term contract reform. I understand from talking to the BDA, that the quick wins, to quote Eddie Crouch, are in “quicksand”. They don’t seem to be heading anywhere very fast. However, from what Eddie has said, it’s only really going to involve a redistribution of the existing pot of money and won’t fundamentally address a lot of the challenges. It might involve a retargeting of existing budget to particular priority groups of patients, for example. But it’s not going to fundamentally change the contract itself. So, it’s disappointing that we are not going to get something that is more substantive at the moment.

‘All this means that right now, it’s probably never been a better time to go private. Practices have held back in the past, sometimes because of loyalty to the ideals of the NHS. However, they are ideals that practices are finding increasingly hard to live up to. We are speaking to so many practices at the moment who are feeling forced to go private because they are not able to recruit associates or not able to retain their existing associates because of competition from private practice. And I think as the treadmill of NHS work speeds up, it’s going to get harder for practice owners to retain associates, who could potentially go and work at a slower pace for the same, or more money in the private sector.

‘So, the NHS is really going to have to pull a rabbit out of the hat quite quickly, if it’s going to stop, as BDA General Dental Practice Committee Chair, Shawn Charlwood put it, the “haemorrhaging of dental talent from NHS dentistry”.

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