We live in interesting times
It seems hard to believe but we are nearly a decade since it was possible to open an NHS dental practice and apply for membership of the local Family Practitioner Committee, then wait for patients to make a path to your door.
2006 fixed the NHS spend and gave the Commissioners total control over delivery of NHS care.
The terms within NHS contracts especially Clause 12
The Contractor shall not give, sell, assign or otherwise dispose of the benefit of any of its rights under this Contract, save in accordance with the Contract. The Contract does not prohibit the Contractor from sub-contracting its obligations arising under the Contract where such sub-contracting is expressly permitted by the Contract.
lead many to believe that the price of dental practices would be adversely affected. However via the machinations that allowed partners to be added and removed from contracts, sales continued and prices rose due to the limits on new start-ups.
So as we approach yet another significant contract alteration, note the new terminology of contract reform rather than a new contract, what lies ahead?
The Health and Social Care Bill compels new contracts to adhere to European procurement law, a minefield in itself and perhaps anything that prevents the need to tender all contracts should be very much welcomed, hence reform rather than new.
The details of any reform are far from clear; the pilots have been going for two years, but from the outset these we were told were for learning not piloting a new contract.
What have we learnt? That prevention takes time and decreases the amount of patients able to sit in a dental chair. A drop in access will not be acceptable to politicians nor patients. That the prospect of a big bang change probably places Civil Servants at the Department of Health into a cold sweat. So much so that staged introduction is now being discussed. What will that mean?
That unremarkably with the variety of dental practices that exist in England, practices have adapted differently to the care pathways that were being tested. Some have slavishly followed the computer assisted treatment guides, whilst others have overridden “The Computer says no”. Practices of different size have reacted differently with the larger ones being able to change quickly the skill mix needed to deliver appropriate preventive care and advice.
At a meeting of the BDA General Practice Committee last Friday, Elizabeth Lynam Head of Dental and Optical services at the DoH said they were looking at modifying patient charge bands to ensure any contract change delivers the total revenue the civil servants must deliver from patients to ensure the system does not collapse.
In the spring there will be consultation on the planned suggestions for a capitation and quality payment system and how this will affect practices that have wide ranging UDA values and totals despite serving similar populations to their neighbours. Some practices after doing the sums will need to attract many more patients to justify their previous high UDA values, some may have to think of how they cope with contracts that do not match the numbers that regularly attend their clinics.
One further development on the horizon is the capabilities of the contractor to deliver varied competency of care. So more complex work commissioned will be only available to those that have shown they have the ability to do it, via some means of assessment programme constructed by the Royal Colleges.
So in this period of time those considering an NHS practice purchase should gaze a little into the future indeed perhaps consider a crystal ball purchase first! Have some plans based on possible scenarios, including ones that consider further development of the practice outside the NHS. Think about the services you hope or desire to deliver and if you have the accommodation to deliver that care from.
The coalition promised that within their term of office they would deliver a new means of providing NHS dental care, with only just over a year to deliver on this promise, it seems incredibly optimistic. No one including the civil servants want a repeat of 2006 introducing an untested model with wide opposition from the delivers of the care, but politicians near election times think more of the imminent ballot than the long term.
Be prepared.
Eddie Crouch: Regional LDC representative for the West Midlands
