DPAS: No light at end of tunnel

The government’s refusal to consider granting a clawback amnesty over UDA targets means the prospects of many dentists continuing to work under the NHS are ‘dismal’, according to Quentin Skinner.

The chairman of DPAS Ltd, the payment collection agent and provider of dental insurance that supports practices in offering their own practice-branded plans, said the decision could prove the last straw for many NHS dentists.

As previously reported on Dentistry.co.uk, the British Dental Association (BDA) had requested an amnesty for dentists who had completed a significant amount – but not all – of their units of dental activity (UDA) for 2006/07. But the Department of Health responded by saying it will not consider waiving financial clawbacks for dentists who have not reached their contract targets.

Mr Skinner said: ‘The British Dental Association (BDA) claims that many NHS dentists are unfairly facing financial penalties as a result of the new NHS contract, and has called for an amnesty on these clawbacks. A request that the Department of Health has refused to consider.

‘The unfortunate reality is that, under contract law, there is nothing unfair about the PCTs properly pursuing the dentists for delivery on their contractual agreements. NHS dentists undertook to deliver a number of Units of Dental Activity (UDAs) in return for an agreed contract value. Where dentists have not delivered, cash-strapped PCTs are inevitably going to seek suitable restitution. Indeed, they would be failing in their public duty if they did not do so.

‘What was unfair, and grossly so, was the appallingly confused mishandling of the design of the new General Dental Services (GDS) contract and the incompetent fashion in which the government introduced it in spring 2006. The final version of each contract ran to over 150 pages of legal wording, and was delivered to dentists with such inadequate notice that many were unable to understand what they were signing up to.

‘They did so because of the Government’s bully-boy tactics; coercing dentists to sign up to a contract at the last minute, or otherwise to face losing their livelihood almost overnight. That was what was unfair.

‘Dentists are now discovering a further area of unfairness – this time in the performance of UDAs in relation to children’s dentistry. Again at the last minute, the government laid down the UDA requirements for child-only contracts on a basis that was completely out of line with the reference year – dentists signed up without realising the consequences. Now many dentists are realising that, despite providing more NHS dental care and treatment on children, they are still nevertheless somewhat short on their UDA targets. Thus the PCTs have screwed out extra productivity from the child-only practices, and are still aiming to claw back the value of the under-delivered UDAs. A good deal for the PCTs, but totally unfair for dentists.’

He added: ‘There should be no illusion as to how this unhappy situation will unfold. The very large number of dentists who have under-performed by more than four percent now face either catch-up or clawback in year two of the GDS contract. Whichever way they turn, the prospects of continuing under the NHS are dismal.

‘Catching up entails doing even more NHS work this year, in a bid to make up for last year – meanwhile the meter will be measuring how the delivery of this year’s UDA commitment is going, with the likelihood that if dentists were significantly short last year, they will be so again this year – and next year.

‘However, the old NHS fee-per-item treadmill has been replaced with a far more vicious, ratcheted treadmill. In reality, there are now many dentists failing to deliver even 75 percent of their contracted UDA delivery, and crippling clawbacks are surely inevitable. Consequently, their ability to protect, let alone earn their livelihood in year two of the new contract is likely to be as challenging as in year one.

‘We are already halfway through year two, and conversion to the private sector takes some time to plan. In order to assist in coping with the financial effect of clawback, and to set their practices on a firm financial footing that is under their control, dentists with NHS contracts should be looking at a change to the private sector as a matter of urgency. Those who keep treading the mill under increasingly harsh circumstances until the end of ring-fencing in 2009 without planning their escape route right now will only have themselves to blame.’

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