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The new contract is national health service capitation in disguise
4th Jul 2006
Editorial Comment - By Julian English With the introduction of the new contract on 1 April, health service dentists lost control of their own future income and signed control over to the government. This cunning political move was sealed when it became apparent that dentists would bear the brunt of the public’s wrath over fees and access. If there was any overspill of bad press, then local commissioning would mop up the rest, leaving the government clean and finally in control of its spending on national health dentistry. While dentists scrutinised the fine print in over 135-plus pages of the new contract, a great dental deception took place right under our noses. Welcome to NHS capitation. With the British Dental Association leaderless and no political adhesion in the profession, nGDS was imposed and we have to live with it now. But forget the potentially bleak future in three years, try three months from now. Dentistry magazine is getting more and more reports from concerned dentists who have smashed their UDA targets early and have hit a proverbial brick wall in renegotiations with their PCT. PCTs have been able to cap financial commitment to dentistry. When the ‘pot’ is empty (and please bear in mind that on 1 April the entire contents of the pot was promised out) there will be no top-up and nothing more forthcoming. But hark; there is this £100 million available for practice refurbishment. If you divide that by the number of committed NHS practices in the country, they’ll all be able to afford a very nice refurb. But is this enough to keep the ‘committed’ content with their lot? Cynically, I doubt the money will actually filter down to dentists. It might get swallowed up in PCT budgeting voids, or be bound up so tight, few will be eligible for a grant. The government now controls the dentistry budget and it is much smaller than we all imagined. There is no growth potential in these new contracts, so NHS care is well and truly capped. The PCTs care only about balancing the budget because that’s what the employees are paid to do. I would not be surprised to see a laissez-faire attitude from the PCT regarding anything not related to control of the budget. Those of you with new contracts have two choices, either accept your lot at the hands of the PCT in terms of its plans for dentistry and available funding, or use this quiet time (when you’ve completed your UDAs early) to discretely move away from the national health service. The government and PCTs are not daft though, and they will start favouring practices that appear to be long-term committed to NHS provision. If you are thinking of leaving the NHS, do it decisively and cleanly, as in the transition period neither patients or the PCT will make it easy for you.
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