What might NHS dentistry look like in the future? – Chris Groombridge joint Managing Director of 543 Dental Centre – a member of the Association of Dental Groups (ADG)
Featured Products Promotional FeaturesPosted by: Dental Design 2nd August 2018
The structure and outlook for NHS dentistry has been changing for some time. Unfortunately, many of the challenges faced for those operating under the NHS banner are finance related. While dentistry is very much a healthcare profession, the way practices operate means that they must have a viable and sustainable business model in order to continue servicing their patients.
PCR
Since March 2016, patient charge revenue (PCR) has increased by 5% each year. As a result of this, the amount of money going to the government has risen from £739,453,773 million to £783,350,077 million between 2015/16 and 2016/17.[1]This has obviously had an impact on patients, as they are paying more for dental care every year. The question is – does the government intend to raise PCR by 5% every year from now on?
NHS dental budget
Clawback for 2017/18 is estimated at £85 million, according to the BDA. However, there is no ring-fencing for the NHS dental budget and therefore we need to ask where this money is going. Is it being reinvested back into dentistry as it should be? With the odd exception of access projects in Yorkshire and Humber, we know this money is largely being used to support the medical primary care and acute care sectors. Therefore, patients are paying PCR thinking that it is funding their dental services, when in fact it is not.
NHS dental contract values
Contract values have remained the same as they were in 2006, except for the uplift of approximately 0.7%. We now have a situation where UDA values could be lower than the PCR in certain areas of the country. For example, a band 1 UDA treatment is currently £21.60, but a practice’s contract value for a UDA might be only £20. As such, the practice would be more profitable if it were to offer these treatments privately, rather than through the NHS. If the PCR continues to rise annually, the number of practices affected will get higher and higher.
This could have a significant impact on a dental practice’s financial situation, because – unlike GP practices which are paid for wholesale by the government, unless they are a partner – the dental business is paid for completely by the business owner. At the end of the day, dental practices have to be financial viable – no-one lives on fresh air. If UDA contract values remain capped except for a negligible rise, and if PCR increases 5% every year, practices will be left with no choice but to consider affordable, family, private dentistry.
The government may or may not be aware of the possible consequences of treating NHS dentistry like a piggybank for primary medical care. In the long-term, if things remain as they are now, it could well mean the privatisation of dental services. The affect of this on patients is yet to be determined. As long as there is still access to essential dentistry for those who need it but may not be able to afford it, the impact may not be detrimental, as costs are unlikely to be very different (relatively) to what they are paying now. The standard of care is also unlikely to change – if anything, it may even improve, if dental professionals no longer have to operate within the restrictions of the existing NHS system.
Impact on private sector
I think the well-established private dental practices would be fairly unaffected by such a shift in NHS dental services. At the end of the day, it’s all about the bond of trust between patient and practitioner that sees the patient returning to a practice time and time again.
Solutions
It’s all well and good highlighting the challenges faced, but I think it’s important to propose possible solutions as well. In this instance, the issue of increasing PCR and decreasing profitability of NHS contracts could be solved by simply raising the UDA values across the board. This could be done through the DDRB (The Review Body for Doctors’ and Dentists’ Remuneration) and by increasing the UDA value by much more than the so far negligible 0.7%. This is a view shared by many organisations in dentistry, including the ADG and BDA – the latter of which recently suggested the need for annual contract uplift to reflect the percentage rise in PCR in a paper for the Annual Conference 2018 of the Local Dental Committees. Another solution would be to simply reinvest the surplus funds back into dentistry, funding prevention programmes and campaigns to raise awareness among the public.
It is crucial that the full consequences of the current system are realised and acknowledge by the powers that be in order for the necessary changes to be implemented. Otherwise, NHS dentistry may be very different in the future.
For more information about the ADG visit www.dentalgroups.co.uk
[1]NHS Digital. Health and Social Care information Centre. NHS Dental Statistics for England 2016-17. Patient charges, table 6a. Pub. 31 August 2017. https://digital.nhs.uk/catalogue/PUB30069[Accessed May 2018]
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