One of my favourite anecdotes is that of the elderly Australian lady who was interviewed on the streets of Sydney by a TV travel show doing a feature on international holiday destinations. Her opinion was sought on the attraction of a number of possible countries to visit and when England was suggested, she looked aghast and said: ‘No way. Isn’t that where all the convicts came from?’
The story is told to illustrate the importance of seeing things from the customer’s perspective; a perspective that might be very different from your own for a whole host of reasons, although I also apply it to myself as a reminder to sense check my interpretation of events and scenarios.
A different perspective
And so it was with the NHS England Call to Action event I recently attended in Newmarket.
Much of the content was focused on the current state of play with the pilots for the new, or should that be reformed, NHS dental contract for those practising in England. I have to remind myself that I approach such meetings from the perspective of someone who has spent most of his 24-year career helping practice owners convert all or part of their NHS dental practices to private care, largely in response to unfavourable NHS contracts.
A risk of which I’m therefore well aware is that I listen to presentations, such as those given that evening by Barry Cockcroft and the owners of a pilot practice in East Anglia, and I tend to be subconsciously looking for the negatives, the downsides and the challenges. So I consciously remind myself that this is my viewpoint and that I need to be more objective, looking at the smooth as well as the rough.
The smooth and rough
While of course there was ‘smooth’, try as hard as I might to make sure I was being balanced, I could not leave that evening feeling anything other than the smooth was significantly outweighed by the rough from almost every professional perspective; practice owners, associates and even the Government.
To be fair, the smooth was in the area of greatest importance – that of patient care – and although the data is at best flaky, what evidence there was pointed to, wait for it, the fact that more time with the patient carrying out a thorough oral health assessment appears to enhance clinical outcomes and patient experience.
However, even for someone like me, far removed from Einstein territory, it was no great shock to discover that as a consequence, the number of patients that could be seen was reduced. In fact, according to the recent evidence and learning report on the pilots, only one practice increased patient numbers, a ‘small number’ maintained patient numbers, while the rest…
The pilot practice that presented that evening explained that they had seen an 11% fall in the number of patients attending and this was causing them some concern because, while their income was protected under the pilot, if the contract got rolled out and they were going to be paid per patient seen, they feared a reduction in income.
They were taking steps to address this by taking on additional nurses with extended duties, but this had created an issue with surgery space. The practice was addressing this by reconfiguring surgeries, although this had cost implications that they were addressing by avoiding installing dental chairs, as such sophistication was not necessary for the roles undertaken by the nurses.
One can only applaud their positive approach to tackling the problem but looking around, it was not easy to spot other practice owners that felt in a position to replicate those particular solutions. The owners of single-handed practices seemed to be shifting particularly uneasily in their seats.
Even after all these measures were introduced, it seemed far from certain that they were going to have the desired effect, leaving the potential for significant extra cost and a remaining, if slightly lessened, challenge over patient numbers.
Of course, this wasn’t a concern just for the practice owners in the room; Barry Cockcroft looked decidedly uncomfortable about the whole access issue making a quiet reference to the need for access to be addressed at some point, somehow. And no wonder. Successive Governments have beaten the ‘improved access’ drum and here we are, some considerable way down the line to testing a new contract.
More information needed
So where do we go from here? The extension of the pilots makes sense from the point of view of needing to gather more robust data as what is currently available leaves too many questions not fully answered. However, the extension makes even more sense from the point of view of the Government and NHS England trying to buy time to work out how to find their way out of this difficult situation.
Describing the current contract as a failure (the Tories) and NHS dentistry as a national disgrace (the Lib Dems), doesn’t leave you an awful lot of room for manoeuvre if your preference right now would be to do nothing. So it might be argued that this situation leaves two options – persevere with rolling out what appears to be a flawed pilot contract or, perish the thought, rush out something untried and untested.
I know that this might be seen as a convenient conclusion to reach from someone who comes from the perspective of helping dentists leave the NHS, but as news about the potential contract starts filtering out, I’m sure it will not be a surprise to learn that Practice Plan is getting noticeably busier as more dentists are exploring the options for a future less reliant on the NHS. It could be an interesting few months.