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GDS contract now confirmed
1st Sep 2005
The Government has published draft regulations for both new GDS and PDS contracts. They apply only to England, but the Welsh Assembly Government is expected to publish its own version. The regulations for new GDS and PDS contracts are identical in most respects. There is, however, a section of the PDS regulations which gives dentists with a current PDS contract the right to a GDS contract, if they provide a full range of services, not just orthodontics; otherwise PDS dentists can have their scheme made permanent, but under the new regulations. According to the Whitehall, units of dental activity (UDAs) will be the only means of measuring dentists’ activity. Out go item of service, capitation and registration, replaced by this one measure. The proposed dental charges system provides the basis for UDAs. The number that each course of treatment attracts depends on what is provided, for example: Band one - one UDA Band two - three UDAs Band thre - 12 UDAs. Once a year the PCT will review dentists’ figures and will expect them to be within 2% of their target. How the dentist achieves the target is for them to decide and manage their practice accordingly. Provided the dentist achieves the target set for UDAs, they are free to do what they like in their free time, whether it is seeing private patients or improving their golf handicap. It is not the PCT’s business. PCTs face a serious challenge in trying to secure services for people living or working in their area, without a registration system that obliges dentists to see all on their lists, an obligation that will go. Mandatory Services and Advanced Mandatory Services are new terms in dentistry. The former are those services currently provided in the GDS, ‘to the extent that is necessary to meet the reasonable needs of its patients.’ This would exclude services provided for cosmetic rather than health reasons. The circumstances under which a treatment is ‘necessary’ appears to be left to the clinical judgement of the dentist, but could lead to disputes with patients and PCTs.Advanced mandatory services are defined as those services, which ‘by virtue of the high level of facilities, experience or expertise required in respect of a particular patient, the service is provided as a referral service.’ Dentists may decide that they do not have sufficient ‘experience and expertise’ to tackle molar endo or complex perio, surgical or prosthetic cases. In the future they may be calling for adequate referral facilities which the PCT will have to arrange, perhaps by dentists with special interests, another challenge for them. Out of hours services become the responsibility of PCTs. During so called ‘core hours’ dentists have an obligation to see those patients currently under treatment. Outside these hours and for patients not currently under treatment, responsibility lies with the PCT, an obligation they can discharge by commissioning out of hours care from GDPs. What is missing are the financial details, covering what dentists are paid, although the Guidance lays out the Department’s proposals for these, which will lay down what PCTs must pay dentists under a GDS contract. It will also set out how the dentist’s contract value and the number of units of dental activity will be calculated (using October ‘04 to September ‘05 as the base year). They will also set out how the three-year guarantee of gross earnings, will apply. The Department will also say how payments and allowances, such as seniority (to continue for two years), vocational training, maternity, and reimbursement of rates will apply. Dental reforms planned for April 2006 are in danger of failing to deliver the intended benefits to patients and dental teams, warns Denplan. ’The reforms are being hampered by ‘old world’ issues - the Personal Dental Services (PDS) model, local PCT control, and chronic under-funding,’ said Dr Roger Matthews, Denplan chief dental officer. With PDS being trialled at a percentage of dental practices across England, Dr Matthews believes its potential pitfalls are being widely exposed. ‘Primary Care Trusts (PCTs) are effectively given full access to and potential control of independent dental practices,’ he warned. ‘Dentists ought to be aware that PCTs will have the right to total disclosure of all patient records for example, even with a limited list contract. The ownership and value of practice goodwill could be at risk.’ Dr Matthews also advised dentists with NHS commitment to take a cautious view of the three-year ‘guarantee’ on income, saying it is a very short period on which to base future business development - and it will end at precisely the time when annual financial increments to the NHS as a whole will be reducing, putting further pressure on the availability of local PCT funding.
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