I have been hoodwinked and I don’t like it. When the Steele report was published in June,
the secretary of state told the profession and the NHS that he accepted the recommendations
of the report. He said his Department intended to ‘work closely with the NHS and the profession to pilot the recommendations’. I have to confess that I believed him; I no longer do.
While Andy Burnham was all smiles to the profession and the British Dental Association (BDA), others in his department – notably Dr Mike Warburton and James Gold, head of the commercial team at the Department of Health – were devising a very different contract to be offered to dentists who wished to take part in the Dental Access Programme this autumn. Granted, it is based on Jimmy Steele’s recommendations that UDAs should not be the sole currency of the contract, but it adds another layer of bureaucracy and targets and is totally unsuitable for any small practice. Perhaps that is the idea.
Steele mentioned pilots many times. One of his key statements was: ‘We recommend the
development of contracting forms and incentives to reward continuing care, activity and quality. These should be developed via a centrally managed set of pilots and robustly evaluated.’ He also said that there was an opportunity to pilot several of their recommendations through the Department of Health’s Dental Access Programme.
The new contract is not a pilot; it is the real thing. If successful, in the Department’s eyes, it could well be rolled out across all contracts, not just those in the Access Programme. In this contract 51% of your pay will be for UDAs, thus cutting their value by half; 19% will be in the form of a payment per appointment per ‘regular patient’ and 30% will be for ‘performance’, as defined by certain ‘key performance indicators’.
If you don’t achieve these in full then that aspect of your contract payment will be cut. These penalties could apply for instance if more than 45% of your patients attend at six-monthly intervals, or if less than 80% of your patients have had their smoking status checked. Another requirement is that any patient who turns up without an appointment must be seen that day.
Steele said: ‘Dentists are suspicious of government motives towards NHS dentistry.
Any underlying suspicion was not helped when some of the aspects of the reforms were
introduced without piloting.’ Despite the health secretary’s apparent acceptance of the review, his department is doing the same thing again. That is why I say I have, and the profession has been, hoodwinked.