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Editorial Comment: Mixing opportunities
14th Feb 2006
Julian English reports Early Primary Care Trust (PCT) (PCT) returns in England to Strategic Health Authorities indicate a very much higher interest in signing up to nGDS than predicted. At the same time in the last six months more dentists are choosing private capitation products than in the past five years. Stephen Gates of Denplan said, ‘Over 1,000 practitioners have booked to attend conversion workshops over the next two months. We have specially increased our staff. GDP(UK) a web-based chat forum, always a useful litmus paper for the more vociferous, recorded 745 posts in January almost all of them on contract issues. Are all these indicators compatible? Whilst Richmond House may take comfort from the number of Dentistry Magazine readers signing up it would have to be an optimistic CDO to talk about unqualified success. The next six months will be critical. There is a cliché amongst lawyers that says: ‘If you want justice do not go to law. If you go to law all you will get is the law’. The same could be said about health ministers. If they want high quality NHS dental services they should not coerce GDPs into mandatory contracts. If they want mandatory contracts they will get mandatory contracts. Just one example. After April Dentistry predicts that the defunct item 17E (code 1726) will arise like a phoenix from the ashes. There is also the possibility that the acrylic might be cold cured in a preformed celluloid crown former. Listed in band 3 (12 UDAs) the crown will commonly be seen in remitted charges patients. A crown is a crown, is a crown. After all both Procera and an acrylic crown are crowns. The ingenuity of NHS dental practitioners to interpret regulations knows no bounds. The culture has had 58 years to develop. At a recent joint Barnet LDC/PCT meeting a local practitioner got up and said: ‘I have a mixed practice, 50% private and 50% NHS. What do I do if suddenly my private patients say they want NHS treatment’. Without a flicker of an eyebrow the Primary Dental Services Project Manager retorted ‘You have to see them as NHS patients’. This gautleiter pronouncement has enormous possibilities. Dentists signing nGDS should not resist hitherto private patient’s requests for NHS treatment? They should actively encourage it. Since what is and what is not required to secure oral health is a clinical decision the opportunities of mixing are limitless. All that is needed is to identify one service in a treatment plan that attracts legitimate UDAs. How the fees are split then becomes a simple bookkeeping exercise. Arising from this nMixing are two absolutes. The first concerns a meticulous and unambiguous presentation of each and every treatment plan and estimate. This will take practice time. Should such plans and fees alter during treatment a new estimate will have to be drawn up. Such estimates will not be dissimilar to the largely ignored FP17DC procedure. As a result of the 2001 Office of Fair Trading report, PCTs have been told not to tolerate any uncertainties. Patients must be absolutely clear in their mind concerning the nature of the contract and fees payable. Openness and transparency are the ground rules. Dentist who chose to ignore the rules should get off the playing field. The second absolute is to decide in your own mind before embarking on any nMixing what you consider to be necessary to secure oral health. Consider the words ‘reasonable, proper, necessary’ and ‘usually’. Ask yourself if an acrylic denture is a ‘reasonable and proper’ replacement for an upper central in an otherwise perfect dentition of 27 teeth. Must a broken down molar have a gold crown or will a confluent-compound amalgam on pins answer to the definition of ‘proper’? The bottom line must be what you are willing to defend in front of your peers. Whilst it is still not known how problematical clinical judgements will be resolved the threat of a variation or termination of contracts is an empty one. The reason is that somewhere in the process other general dental practitioners must be involved. Clinical decisions cannot be determined by lay managers or by Consultants in Dental Public Health. You will always be entitled to be judged by your colleagues. The ultimate backup will be the rottweilers. For the defence organisations the meaning of words is a sport. nMixing is a great opportunity. It means that with carefully taking patients into your confidence together with staff training in the necessary paperwork you can have your cake and eat it too. Those practitioners with the common sense to see into the future will accumulate their UDAs without difficulty whilst gradually carrying out a conversion. When it’s all over in three years time they will be left with secure viable private contract practices and goodwill. The rest will be doing sessional zinc oxide clinics in surgeries that are little more than access centres. They will still be labouring under the delusion that they are independent contractors.
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