Nigel Jones speaks to Eddie Crouch, Vice Chairman of the BDA, ahead of his appearance on a panel discussion at the British Dental Conference and Dentistry Show…

Next year could see a lot of change in the NHS dental landscape, as the reformed contract starts being rolled out to practices across England. The details of what those changes will be and how they will happen is still uncertain for many dentists.

To find out more about what the reform process so far can tell us about what might lie ahead, I spoke to Eddie Crouch, who will be appearing on a panel discussion at the British Dental Conference and Dentistry Show to talk about what is next for NHS dentistry…

Nigel Jones (NJ): The NHS Long Term Plan was published earlier this year, what is the BDA’s take on how dentistry featured?

Eddie Crouch (EC): It was mentioned…I did find a few lines in there about dentistry. Not long after it was published there was an event in Parliament where I understand, Sarah Wollaston, an MP and member of the Health Select Committee, and Simon Stephens, Chief Executive of NHS England were present. I understand she asked why wasn’t there more about dentistry in the plan, and allegedly was told  ‘the plan only had 50 pages and NHS dentistry takes up about 3% of the NHS budget, so it got the amount of lineage that it was probably expected to get’. There was some mention in there about the terrible number of children having general anaesthetics and the ageing population and domiciliary visits in care homes, but you have to search hard to find it.

NJ: Contract reform is on the horizon with the roll-out starting from April 2020, what is your sense of how the different prototypes are working for practices?

EC: From the BDA point of view, we have a preference for type B because so much more of the payment is not connected to the UDA. The analysis of the programme shows that four in ten practices on a GDS contract will face some form of clawback at the end of this financial year, in the prototypes it’s a one in four chance. To me, that doesn’t look like it’s a successful system. And if you’re in type B your chances of clawback are less than in type A.

What we’re seeing is that to make the prototypes work, some people are having to work excessively long hours, recruit additional staff – and we all know about the recruitment and retention issues so that’s not easy to do – and spending a lot of extra money in actually delivering the service, simply to avoid clawback. There are probably people trying to do that in GDS practices as well.

If the calculation of capitation is wrong for a practice then a roll-out will be really quite hard to deliver, and some of us would argue that in 2005-6 the calculations done on UDAs were deliberately inflated to make it harder to deliver. If the calculation is correct, so that if you work in a high-risk area and look after a high needs patient you are properly remunerated, then I can see some benefit – but I’m not seeing the evidence for that at the moment.

NJ: You mentioned the recruitment and retention issues, does the BDA have a view as to how workforce planning is shaping up in the future?

EC:  Part of my role at the BDA is to give evidence at the Doctors and Dentists Review Body (DDRB), and every year it’s been protracted and gets later and later – most recently we had a contract uplift way into the financial year. This year the DDRB report isn’t even coming out until the 2019/20 financial year, so I’d expect a delay in anything this year as well.

In their submission, NHS England said there wasn’t a recruitment and retention problem. Three months later they put in a meeting at the BDA to discuss the recruitment and retention problem. I’m not sure what ‘Road to Damascus’ moment happened between those two things.

At a recent meeting at the GDC, everyone who was speaking at the event said that the contract, as it stands, just does not allow for skill mixing and doesn’t support DCPs doing some of the work of dentists, having an effect on meeting UDAs and delivering prevention. If we could start to do that in practices, we could begin using the skills of the whole team more productively without the risk of clawback.

NJ: How do you see the roll-out of the reformed contract happening?

EC: From the BDA’s perspective, we want the flexibility for practices to be able to choose whether they want the A or B contract – not to be instructed about which one they should choose. The practice knows best what works for them so we don’t want it to be a false choice of ‘stay where you are or move into this’.

However, my feeling is that that’s probably what will happen. We won’t be given that flexibility. For example, if you start off in a B and it wasn’t working for your practice after a year or two, will you have the flexibility to move to A? I’m not sure we will be given that flexibility at all and if we aren’t, there could be a lot of practices failing.    

The Department of Health says there will be no compulsion to join one of the new contracts but there’s not enough insight into the implications of the roll-out yet.

NJ: Eddie, as always, it’s been another interesting discussion, I look forward to continuing the conversation at our panel event at the British Dental Conference and Dentistry Show.

Eddie will be speaking as part of two panel discussions on ‘What Next for NHS Dentistry?’ alongside other peers including Simon Thackeray, Tony Kilcoyne, Paul Worskett and Ian Redfearn. The panels will take place in the Dental Business Theatre as part of ‘The BIG Questions’ on Friday 17th May and on Saturday 18th May from 2.15pm – 3.15pm. 

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