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a blog by Chris Barrow

NHS dentistry? It just ain't worth it.

Just when you thought you were heading for a Christmas break, yesterday saw the the BDA announcement regarding their refusal to accept the targets and conditions for the delivery of NHS dentistry in the first quarter of 2021.

"The government’s move to impose new targets in England will pull the life support away from NHS dentistry and undermine patient care, argues Dave Cottam, GDPC Chair.

Today we have refused to sign up to a deal which will see practices face steep financial penalties if they are unable to hit 45% of their pre-pandemic UDA targets.

Those that fall just below 36% of the activity target are expected to face a 'cliff edge', where they would have to return a significant majority of their NHS funding for the period from 1 January to 1 April 2021 and face potential breach of contract. This is a crucial step backwards for practices already struggling to stay afloat. In a nutshell - practices will face huge financial penalties chasing impossible numbers.

This logic has no place in a 21st-century health service in the middle of a global pandemic."

On last night's Business Confidence Forum (a record audience turn out, for obvious reasons) I had the privilege of facilitating a lively debate on this subject, including an enlightening and worrying explanation from dental accountant Alan Suggett of how the "cliff edge" mentioned above would catch out the unwary, complete with a hurriedly prepared and hand-drawn graph reproduced above.

It's my expectation that Alan will formalise this and, perhaps, run his own UNW webinar sometime soon to take a more detailed look through the numbers and point out the potential dangers. For now - well done Alan for "having a go" last night at helping the dental community to make sense of a bewildering change of goal posts.

This morning over an early cup of Earl Grey, I read slowly through the more detailed guidance published by the BDA yesterday.

Putting myself in the shoes of the independent practice owner, I asked the the following questions:

  1. The week before Christmas, when I'm exhausted and working flat out to meet patient demand before the short break, have I really got the time and energy to absorb, understand and plan for all this change, imposed on with just 14 days notice?

  2. How am I supposed to offer a compulsory triaging service but no longer get paid for it?

  3. How am I supposed to prioritise care for patients in line with contractual obligations, when that prioritisation handicaps my ability to hit the targets imposed upon me?

  4. Why will I be expected to sign a series of declarations, agreeing to share confidential information on the provision of private services, as well as a commitment to obey the rules - don't you trust me?

  5. How am I supposed to enter into a contract variation with my associates (and selected others) in the next 2 weeks, introducing measures to monitor, pay and penalise said clinicians and team members by reference to unprecedentedly complicated formulas that have not yet been clarified?

This morning I sat back from all the listening and the reading of the last 24 hours and the only sense I have is that NHS dentistry is no longer a place to be for the independent.

I'm proud of our NHS, I stood on my doorstep every Thursday night and applauded just like everyone else.

I'm equally proud that in 26 years of dental business consultancy, I have never said that "private dentistry is better than NHS dentistry" - simply because I've met heroes and villains in both sectors and I've heard clinical stories of heroism and cowardice from both sides.

However, this morning I feel like suggesting to all my clients in mixed practice that it's time to seriously consider getting the hell out of Dodge.

The insensitivity, the bureaucracy, the lack of respect and appreciation, the burden, the hypocrisy, the politicisation.

Most of all the insensitivity - whether it's NHSE or the DHSC doesn't really make any difference to me.

NHS dentistry is now a world best left to the corporates, with their armies of box-ticking bean counters and institutional shareholders with deep pockets and moveable balance sheets. Leave them to deal with the self-preserving minions of Government. It's a good match.

Frankly (and in the language of a 50's British crime movie):

"Leave it alone - it just ain't worth it".

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