The issue of the huge variation in UDA values in practices throughout England, and sometimes even on the same street, is one that has been challenging the dental profession for some time. While the rollout of a new contract could be the ideal opportunity for some sort of harmonisation, that seems a long way off with little incentive for Government to disturb the current uneasy equilibrium. Here Tony Kilcoyne shares his views on this issue.
‘This is a critical question to which every NHS dental practice in England wants to know the answer, since, as we all know, the very survival of NHS dental services depends upon UDA values being viable.
Sadly, I fear, due to extreme short-termism by the Government, the short answer is yes, and, for the majority, it is most likely that UDA values will fall.
This is, of course, crazy given that UDA values were set over a decade ago, before the financial crash, new regulation costs, indemnity rises and ARF increases – to mention just the tip of the outgoings iceberg dentists have been hit with in the last few years. And all to be paid from a fixed NHS budget.
“Sadly, I fear, due to extreme short-termism by the Government, the short answer is yes, and, for the majority, it is most likely that UDA values will fall.”
In reality, a significant extra-cost burden means fewer resources to treat each patient well. Something must give: it’s a mathematical and undeniable fact that can’t be explained by efficiencies or salary cuts alone, as these are already pared down to the bone.
So, if the Government were looking to achieve a 20% cut surreptitiously, one option might be to force NHS practice contractors to bid against themselves and other unknown parties – for the same job, for less money and working more hours too, including weekends! You couldn’t ask your staff to bid for their own jobs under such pressures, but aren’t established NHS contracting practices in a similar ‘monopolistic’ employed/paid situation?
To add fuel to the flames, you (the NHS contractor) have no real idea if others will deliver as well as you’ve already proved over the long term. But the stranger’s word will be accepted and you’ll risk being unceremoniously kicked out, without even asking patients their opinion, despite the Government’s claim that they are in favour of patient choice.
So, is this fanciful? Sadly not, and it’s already started, with our NHS orthodontic colleagues whom, it seems, NHS England are experimentally proposing to require to ‘bid’ for their existing UOAs. Thus, in my new role as part of the BDA PEC, I was pleased to authorise legal action against NHS England for any unfair practices in nhs contracting.
As more details emerge, I am horrified about what this means for patients who have no proper say, the potential disruption this causes to their continuing care and, of course, the lack of security for dentists to plan and invest in future high quality services and care.
“Experimental UDAs have already been roundly condemned by most bodies, not least the Government’s own cross-party Health Select Committee since 2008.”
Experimental UDAs have already been roundly condemned by most bodies, not least the Government’s own cross-party Health Select Committee since 2008. Perpetual pilots have cleverly hidden the Government’s inaction since. And in the meantime, above-inflation NHS patient charges have increased to their highest ever levels. This means UDA contract values will be less – or barely more than – those NHS patient charges, resulting, ultimately, in a more stretched, underfunded per-patient service.
It looks as though paying NHS patients are just one step away from effectively ‘privately’ self-funding their nominal NHS UDA dental care, through these back-door tricks. If cuts have to be made, they should be done openly and transparently, not disguised in an enforced lowest-bidder, dumbing down, dangerous experiment that has never been trialled. Just when you thought the errors and incompetence of the 2006 imposition of UDAs couldn’t be beaten, this might just take the biscuit.’
At the outset of the contract reform programme, it was widely hoped that any new contract would see the end of the UDA system. Yet with so many uncertainties surrounding the reform, not least when it will actually happen, it’s a distinct possibility that the UDA system, with all its weaknesses, including the variation in value, will be around for some time to come.