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The new contract – your questions answered
14th Feb 2006
Graham Penfold, operations director at Practice Plan answers the key questions about the new contract
1. Should I check my UDA budget?
Yes. We are receiving an increasing number of reports of dentists who have audited their UDA budgets and who claim that they have found them to be overstated by as much as 20%. In addition, the assumption for children is that they all attend twice a year.
Our advice is that you should perform a thorough audit on your UDA quota and, if necessary, obtain a detailed print out of the calculation from the DPB. Finally, you need to ensure that the ‘Test Period’ that was used, namely 1 October 2004 to 30 September 2005, accurately reflects the activity that is currently occurring in the practice.
2. Will I be allowed a child-only contract?
Restricted contracts, as they are known, are only granted at the complete discretion of the PCT. Our experience to date is that practices that have been predominantly private for some while are being granted this type of contract whilst those who have converted either during or since the Test Period of 1 October 2004 to 30 September 2005 may experience some difficulty in obtaining a restricted contract.
3. I am in PDS - how will the changes affect me?
The changes will affect you in a number of ways. First, you will have to operate the new patient charging regime.
Second, you will have to agree a UDA target with your PCT and you may face pressure to increase this over and above recent historic activity levels. Finally, you will have a time limited agreement rather than an open ended contract.
Overall in our view, in strategic terms, is that in the longer run PDS and GDS will be indistinguishable.
4. Given the time pressures, should I just sign the contract and work out the details with the PCT later?
Absolutely not. You should read the contract carefully and annotate any clauses that you disagree with stating the reasons why and signing and dating each disputed paragraph. We are aware of some PCT’s applying a pressurised approach – it should be firmly resisted.
5. If I am being paid a fixed amount can I book longer appointments?
Well you can providing you meet your UDA target. However, many commentators believe that the main driver of the new contract is about improving access and not prevention or removing dentists from the treadmill.
The only way in which access will be improved is for more dentists to manage larger list sizes under the NHS. This means longer recall interval intervals, providing less treatment and being prepared to see all types of patients – exactly what the new contract proposes – prevention is nowhere in sight.
6. What do PCTs know about dentistry?
By and large not very much! Life in a PCT at the moment is not great fun. Many are undergoing a process of amalgamation so there are real concerns over job security. Staff turnover means that establishing good, clear and consistent communication may be difficult.
They have other challenges such as out of hours cover and the new pharmacy contract and a number have significant deficits so what will happen to dental budgets when they
are no longer ring-fenced
after March 2009 will be
interesting.
All in all not the ideal business partner!
7. How will the changes in patient charges affect me?
The PCTs will receive their budgets net of patient charges. You will still be responsible for collecting patient charges in accordance with the new regime and liable for all bad debts as now. You will need to declare the level of patient charges to the PCT so that they can pay you for any shortfall.
8. What impact does this have on my associates(s)?
You will need to ensure that the associate completes the necessary number of UDAs otherwise this could result in a reduction to the financial value of that part of the contract.
You will almost certainly need a new agreement with them and think about the manner in which they are paid.
It will probably be more difficult for associates to move practices or start their own practice as they will require agreement and funding for their new position from the PCT.
9. Will I have clinical freedom under the new arrangements?
You will have to sign up for the NICE recall guidelines which we regard as vague at best. We believe that the only parties that should influence the recall interval between dental examinations should be the patient and their dentist. It is highly dangerous territory to start trying to intervene in the patient/clinician relationship especially when evidence is very thin.
10. Will the new contract address the underfunding issue?
No. Dentistry has been excluded from the NHS escalator and PCTs have been given very little headroom for movement. Also, many PCTs have deficits and the NHS dental budgets are only ring-fenced for dentistry until March 2009 so under-funding is just as potent a force as it always was.
11. How will the new contract encourage prevention?
We do not believe that it will – we believe that neglect will be encouraged. Put bluntly, every time you perform a treatment, especially a laboratory based procedure, your profit will fall. Similarly, if you spend time with patients trying to educate them about their oral health then you may well record insufficient UDAs.
There is no incentive to have a hygienist or oral health educator whatsoever so the claim that the new contract has a preventative focus we believe to be false.
12. Is my goodwill affected?
Some commentators say not but just consider two facts. First you will have one contract for all your patients for the whole practice with the PCT rather than thousands of individual registrations. Prior to new contract only the dentist and the patient could decide to alter the status of the registration.
Now the main client is the PCT and it is they who hold the purse strings. Clearly, the risk profile between these arrangements is totally different and that factor is so important that it must have a significantly adverse effect on goodwill.
In addition, and as important, if a dentist decides that the new contract is not for them and they decide to write to their patients to that effect then there are significant issues as well.
Not only does the dentist have to give the PCT three months notice, they also have to cooperate in effectively handing over their patients to another NHS dentist by providing the PCT (or another practice) will all the patient information that they require! This is totally different to the existing system where the only information that needed to be provided was patient surname, initial, gender and date of birth.
This enabled the patient to be identified for de-registration purposes but not contacted by the PCT. The new contract effectively gives ownership of the practice’s patient database to the PCT! For those in doubt refer to clause 357.3 of the standard general dental services contract.
What value is goodwill now?!
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