With an additional two years of prototypes planned, Nigel Jones questions when enough is enough.

The invitation from NHS England for expressions of interest to become a fourth wave prototype practice brought further confirmation that the prototype regulations have been extended for another two years.

This is, of course, being positioned as further evidence of the desire to get the contract design perfected before undertaking any major roll-out.

However, there’s been no change to the structure of the prototype contracts – despite widely reported issues, as typified by 2018 LDC chairman, Joe Hendron’s open letter resigning from the reform programme that he says ‘has lost its way’.

Some cynics might suggest that inviting new practices to the party could be an attempt to dilute the negativity surrounding the current approach, given that those prototypes that have struggled the most have also previously been in the pilot programme.

Others might believe that it’s simply another example of NHS England buying time after painting itself into a corner, by creating a contractual structure that has much to commend it but will be unaffordable for either the Government or the profession.


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Whatever the reasons, it means two further years working under the current contract, which, if the evidence submitted by the BDA to the Review Body on Doctors and Dentists Remuneration 2018/19 is anything to go by, will be a very long two years indeed.

The BDA’s submission makes for fascinating, if depressing, reading and pulls few punches in highlighting the extreme pressure felt by dentists trying to deliver patient care under the current NHS arrangements in England.

Amongst the many sobering statistics, such as poor morale and reducing income, one that caught my eye was the huge hike in clawback, from £54.5m in 2015/16 to £81.5m in 2016/17, a trend that looks like it’s continued in the current year.

This is a stark indicator of the current contract’s failings, which dentists are working harder to shield patients from, in return for diminishing rewards, and one has to wonder when enough is enough.

Many are likely to reach that point before 2020, but that requires thought and planning, starting now.