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Supply and demand effect
29th Mar 2006
When the new contracts starts in April 2006 you may initially have noticed little change, despite the hype that it was the most significant change since the NHS started nearly for 60 years ago. On 3 April, if you are still in the NHS, you will probably see a normal list of your usual patients, and on 3 May a bank credit will arrive, together with enhanced cash flow in the early months, as the last of their treatments under the old system are paid. As the months pass your payments will remain unchanged. But you may well find that there is a strong incentive for you to adopt a minimal intervention approach, reducing the content of each course of treatment. For many patients, however, the charges will be seen as a large increase. There may be a tendency to postpone treatment until ‘something needs doing’. From these factors two possible scenarios appear most likely to occur, although it is impossible to predict with any confidence which one will occur. There have been many instances where a perceived reduction in supply has led to increased consumer demand. Most recently the fire at Buncefield fuel depot last year led to queues outside petrol stations although there was in reality no shortage of supply. In the ‘supply scenario’ with dentists refusing to take up the contract and opting for the private sector there is increased demand at those practices that stay in the NHS. Newly private practices retain sufficient of their patients to remain viable. PCTs commission NHS practices to reserve more of their time for ‘urgent treatment’, leaving fewer hours available for ‘follow-up care’ and less ‘continuing care’ such as regular recalls. Those who can afford to do so increasingly opt for private treatment increasing the viability of practices, leading to an increasing polarisation of practices, with some providing private treatment and others NHS care, increasingly only for those with some dental problem, who cannot afford or do not want to pay private fees. Public spending on dentistry goes down as fewer dentists remain in the NHS sector. Most dentists sign up to new contracts if only to ‘test the water’ and secure their cash flow for another year at least. They will decide on the basis of their experience whether to stay in the NHS or convert some or all their practice to private in future years. Patients, in the main, continue to see their ‘usual’ dentist. The new patients charges, however, act to reduce demand, for longer recall intervals and a less-intervention approach. Dentists’ quotas for UDAs remain. Dentists no longer have waiting lists and will start to have gaps in their appointment books. They will need to see more new patients in order to achieve their UDA quotas (see story on front page). The public will find that they can obtain NHS treatment from established NHS practices and those who have become private patients under duress seek and find NHS care. Established private practices retain their existing patients, but those who have converted to private more recently find that demand for private care is reduced, but they will be unable to obtain a new NHS contract, so may have to revise their charging structure and market their services better. Julian English, Executive Editor
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