What does the UDA contract pay for?

UDA units of dental activity

Michael Watson clarifies what the UDA contract actually covers

Michael Watson explains how the UDA system came about and how it is supposed to work in the practice.

The Times article titled ‘The great dental rip-off’ still gives rise to comment within the profession and outside.

It claimed that thousands of teeth were ‘needlessly extracted’ as surgeries were accused of ‘putting profit before patients’.

The paper had also found that some dentists earn almost £500,000 a year in a system that ‘rewards them for cramming in as many patients as they can’.

Dozens were claiming for the equivalent of more than 60 check-ups a day, in what has been condemned as an unethical conveyor-belt approach to patients.

Desmond D’Mello

The article was published in advance of the fitness to practise hearing of Desmond D’Mello, who reportedly had a contract for 29,000 UDAs (units of dental activity) at a value of £750,000.

But it should be noted the case, which he refused to attend, was about hygiene standards, not his volume of work.

These high contract values and UDA requirements were based on work done in a ‘test year’ preceding 2006.

They represent a great deal of hard work, which was audited by the Dental Practice Board (including investigation for fraud) and subject to examination by dental reference officers.

When the new contract started in April 2006, it removed the requirement to do a lot of work to earn this money.

All you needed to do was a simple examination (£8.05 in Scotland and Northern Ireland, who still have item of service), add a filling (£16.90 in Scotland and NI) to claim three UDAs and a crown  (£128.10 in Scotland and NI) for 12 UDAs.

Add to that the removal of the requirement to look around the mouth and do anything that might need doing and make the patient ‘dentally fit’ and the effect of the UDA system was to wean dentists off high fee courses of treatment in favour of simpler ones.

In that they were following the teaching of such as Professor Elderton, who in an article in the International Dental Journal (1993) wrote: ‘many dentists continue to be powered by an aggressive restorative approach, which may result in unnecessary treatment and which must now be seen as inappropriate.’

Winners and losers

The idea that a dentist should not do everything that can possibly be justified lies at the heart of the clinical pathway approach that underpins the pilots, the prototypes and the forthcoming new contract.

Those who carry out short courses of treatment benefit under the UDA system; those that believe they need to do 10 fillings and three root treatments for three UDAs lose money.

Whether it was a good idea to introduce a new way of working into what is essentially still an item of service method of paying is a moot point to say the least.

3 Comments

  1. 1

    The problem with cases like D’Mello is that his contract really ought to be done by at least 5 dentist – not 2 part time ones. He had no chance of meeting basic hygiene requirements but equally any form of dentistry to any acceptable standard. Perhaps he was gaming in the past? This was wrong then and wrong now.

    His ridiculously high contract, in a now budgeted system means far less money for front line services which means fewer working dentists, fewer DCP’s, fewer nurses, fewer independent practices?

    The real shame is that cases like his could easily be checked, monitored and prevented. Dentistry magazine and dentistry.co.uk has been at the forefront of highlighting high UDA claiming which I believe is damaging the profession far more than people think – post 2006 we now have a budget for dentistry set by the DoH, we need to have an urgent conversation how this money is fairly spread amongst the profession.

    Neel

    • 2

      The idea of controlling how much work one can do is ridiculous! How do you arrive at the figure 5 as the most appropriate number of dentists for such a contract value? There are dentists working six days a week and getting high number of UDAs. You talk of DoH allocation and the effect of hard work preventing other dentists/nurses etc from getting a share of the pie! This is an independent society where one is supposed to work as hard as one feels! We know of dentists who take 40 minutes for a single filling which turns out to be less than satisfactory. I hope these kinds of ideas you have get no place in a free society-we need freedom to perform our work ethically without looking over our shoulders. I know of many dentists who had more than 15000 UDAs before this saga but have now decided to cut down due to unnecessary interference and negative comments from people like you-and they are decent guys. A bad dentist is bad whether he has 10 or 1000.

      • 3

        And yet people like D’Mello, Dr Joyce Trail, Jayantilal Mistry, Dr Atkinson, Dr Muller etc etc continue to blight our profession.

        It’s not me who has budgeted NHS fees it’s the DoH. Why is it fair that some can do 15,000 (bonkers!) when there are many struggling to find jobs and work to any decent standard?

        You talk about freedom to work ethically, D’mello often saw 50 patients in a single morning session. Let’s stop pretending that this is acceptable behaviour. It’s completely unfair on those playing by the rules.

        Neel

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