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UDAs - 'U's 'D'entists 'A're 's'aved or 'U's 'D'entists 'A're 's'crewed
14th Feb 2006
High street GDP Shalin Kapoor has worked entirely in the NHS since qualifying. He discusses whether the new contract will save or sink UK dentists Shalin Kapoor BSc, BDS, qualified from Guys Dental Hospital in 1996. He has been involved in NHS dentistry since qualification and has a dedicated NHS practice in Hounslow, Middlesex. He is also the Founder and Clinical Director of ‘The New York Dental Office’ in Brentford, Middlesex which won the award for the ‘Most Innovative Dental Practice’ at the Private Dentistry Awards 2005. Having worked almost entirely in the NHS since qualification nearly 10 years ago, I have regarded the system as part of the family. The DPB was like my strict granddad who never gave compliments but always told you off at any opportunity, the PCT Contracts Manager was like my mother who always tried her best to keep you happy even when you shouted back at her for not getting things done for you on time and the DPB helpdesk was like the cool auntie who was always at the end of the line to help you through difficult situations. I felt safe in the bosom of the NHS. I knew she would help me in my old age (NHS pension) and that together we were doing some good for the less fortunate people of this country. But something was about to change, something was about to rock the ‘HMS NHS’. Was there an iceberg approaching or would it be calm seas and tropical islands ahead? No one knows but the uncertainty of these significant changes being enforced in April 2006 is making me reach for my life jacket. At the centre of these changes is the UDA (Units of Dental Activity) and guaranteed monthly payments. All of a sudden all these hundreds of different codes of treatment will be abolished and there will be three main bands. Band 1 (one UDA point) is preventative and diagnostic, Band 2 (three UDA points) is restorative and Band 3 (12 UDA points) is laboratory based treatments. The three bands will attract three different patient charges. Sounds amazing. No longer do I have to spend lunchtimes with a sandwich in one hand and the other hand on the computer keyboard tapping in individual codes. No longer do I have to have the monthly butterflies in my stomach when I open my schedules to see if the school fees and mortgage payments targets have been met. No longer do I have to rush back from holiday at 11am to start work at midday. No longer am I responsible for out of hour’s emergencies. No longer does my receptionist have to use her maths degree to calculate patient charges. No longer do I have to get permission from Grandpa for complex treatments. You know what it all sound like a dream come true. Roll on April 2006. But I’m sceptical as most dentists are about these changes and the only way to illustrate these concerns is through a case scenario. Patient A needs four molar endos plus four pinned amalgams. This patient would attract a UDA value of three (Band 2). Patient B attends another practice and needs one buccal composite. This patient would attract a UDA value of three (Band 2) as well. According to the PCT who will be looking just at UDAs the two practices did the same amount of work on these two patients. This is totally unfair, especially for practices that all of a sudden have an influx of patients requiring treatments similar to patient A. It will work extremely well for practices who in the test year did a lot of Patient A treatments but after April 2006 only had to do patient B treatments. You see this imbalance could be fatal for the new system. Dentists will want to (but this does not necessarily mean they will) do the least treatment needed to attract the highest UDA figure. This could have serious implications for the future health of the population. I present to you another case scenario. All of us are going to calculate how many UDAs we need to do in a month and apparently we will be monitored monthly by the PCT. Say I finish my requirement by the 21st of the month. The PCT say we do not need to do any more NHS treatments for the remaining month. UDAs cannot be carried forward. Any treatment after the 21st will have to be ‘free (non claimable) NHS treatment’ or ‘private treatment’ or you rebook the NHS patient till the next month. If a dispute starts (and come on, there inevitably will be) we are to send the patient to the already overstretched PCT for them to explain why we can’t see them. Can you now see the iceberg arriving in the distance? The PCT say they eventually want to standardise the price of the UDA with regional variations. The fact is regional variations are not even accurate. Each practice should have the right to retain their UDA price since they earned it fairly and squarely in the ‘test year’. Some practices may see a drop in their income each year as a consequence of this standardisation. NHS dentists are like chameleons they can change and adapt to their environment quite well and they have in the past, but I feel this new contract could be the one that makes us finally crack and leave the ‘family’. Conclusion I really do think the Department of Health are trying to sort out the problems that existed in the old system, but I feel the new system has many more flaws than the old system. April 2006 is no longer a pilot, it’s the real thing and many dentists’ livelihoods and the welfare of their families are dependant on this system working.
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