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New contract: for better or worse
6th Dec 2005
Will patients be better or worse off under the new patient charges, asks Graham Penfold. New local commissioning arrangements will be introduced in April 2006, when dentists working within the NHS will no longer be paid on a fee-per-item basis and must negotiate new contracts with their local Primary Care Trusts (PCTs). Will the patients benefit? At present, NHS patients pay 80% of their NHS treatment costs up to a maximum of £384, with the remaining 20% subsidised by the government. Under the new band system, instead of paying for individual items patients will know the total cost of their treatment from the outset. Patients will pay one band level once, provided treatment is completed within 90 days. Overall, the Department of Health has increased charges to the patient by about one third, although there is concern among dentists that this may not be sufficient. Band 1 - Examination, scale & polish, X-rays, advice - £11, £15 Band 2 - Band 1 plus fillings, root canal therapy, extractions and denture additions - £31, £41 Band 3 - Bands 1 and 2, plus an item requiring laboratory work - £130-£140, £183 Band 4 - Urgent treatment; examination, X-ray, dressing, re-cement crowns, one filling, up to two extractions - £15, £15 Consumer groups have welcomed the simplification of the payment system from over 400 separate charges, which many patients found confusing. Nevertheless, more than half of all patients will pay more, although the maximum charge reduces from £384 to £183 and existing fee exemptions will continue to apply. Dentists will remain responsible for collecting payment from the patients. Will the dentist benefit? The currency for the dentist’s new contract will be Units of Dental Activity (UDAs). The DPB will analyse the period from 1 October 2004 to 30 September 2005 and convert the dentist’s delivered treatments into UDAs using the schedules shown below. The total will be reduced by 5% and tracked on a monthly basis. A 4% tolerance factor will be allowed and a 60 day period to remedy underperformance. The Statement of Financial Entitlements which shows exactly how the contract value will be calculated is not yet available. Some dentists may need to change their practice’s policy to qualify for a new contract. It is increasingly likely that practices whose NHS work is confined to certain age or income groups may not be offered a new contract on the grounds of discrimination, or else a condition of the contract will mean that NHS treatment must be available to all the practice’s patients. Minimum annual contracts will be guaranteed for the first three years, provided the required number of UDAs is achieved. However, the contract payment is net of patient charges, and although any shortfall will be covered by the PCT, delays in remedying the situation could lead to cash flow problems. Problems may also arise when NHS patients ask for private treatment, or the dentist and patient agree that private treatment would be a more appropriate option. Patients cannot be told that any necessary treatment is not available under the NHS, and they must not be misled about the quality of NHS treatment. Combining NHS and private treatment will be bureaucratically complicated in the highest degree. Dentists must also be aware that undertaking private work, particularly laboratory-based work, will impact on their ability to deliver the required number of UDAs. Assuming sufficient dentists accept new contracts, the effect of the new system on most NHS patients is likely to be insignificant. Many dentists, however, in view of the professional restrictions, regulations and guidelines, as well as the perhaps difficult negotiations with their PCT, may decide that this is the right moment to opt out of the NHS altogether.
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