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NHS - Don’t mind doing it for the kids?
4th Jul 2006
It is now three months since the new contract irrecoverably changed the way NHS dentistry is managed in England and Wales. Mark Garner, Denplan’s area manager, assesses how different dentists are handling the provision of children’s care at their practices under the new system. When the new contract proposals were gradually unveiled during the latter part of 2005, one of the major bones of contention for many practitioners was the seemingly inflexible approach towards mixed practice. Another was the halt in offering NHS care to children, subsidised by their private fee-paying parents. The regulations contained clauses that specifically outlawed the acceptance of any patient on the condition that they or another family member received private care, or that they were willing to do so. Consequently, there are now three types of dentists when it comes to offering children’s care alongside private care for adults. These include; ones who accepted a contract for children’s care where available, ones who endeavoured to secure a child-only contract but were refused and ones who proactively decided to move their child patients over to private practice. Each of these has a different tale to tell. Accepted An anonymous Southsea-based dentist provided an insight into what it is like for those working under the new system with a child-only contract. ‘The biggest downside of the new contract has been UDAs. Although you try to ensure that any clinical decisions you make are not governed by UDA values, all the time in the back of your mind you are counting and wondering if you are going to reach your targets,’ he explains. He also said that he is falling way short of the targets imposed by the local PCT. ‘Unfortunately, the ‘‘test period’’ that my targets are based on coincided with my adult conversion to private practice. I tried to warn the PCT that subsequently the number of child patients I was treating would probably fall, but this was not taken into account. Therefore, my UDA targets are obviously far too high.’ He has a meeting with his PCT later in the year and, for the time being, he is hoping to continue working under the NHS. He is adamant that he cannot take on any more patients or do any more work on existing ones to meet the PCT’s targets. If asked to do so, he will opt out of the contract. Either way, he is sceptical as to whether PCT’s are genuinely interested in looking after the interests of practices, who don’t yield money from fee-paying adults. ‘It’s my intention to try to negotiate lower targets. I can only afford to do this because children’s care at my practice is still subsidised by private fee-paying adults. It’s a completely different matter for those practices who are entirely NHS-based.’ Refused Paul Westerman of Cranbrook in Kent, was denied the opportunity to secure a child-only list. ‘Having looked into the implications for myself and the practice with the new contract, I felt nothing other than resignation and defeat. The amount of money on the table to look after my remaining NHS patients simply wasn't enough.’ The effort needed to treat a relatively small number of potentially demanding adult patients offered too little reward for Paul. Consequently, he opted for a children only contract with his local PCT. ‘I advised my PCT in November 2005 that I intended to continue NHS for children only. However it was not until one month prior to the April 1st 2006 deadline that the PCT advised me that they had declined a contract for my child-patients on the grounds that “I had historically treated both adults and children on the NHS.”' With no chance of accepting a contract for both categories of patients, Dr Westerman found himself with no NHS funding for his practice whatsoever. His team battled on and by mid-April the practice had commenced signing the first children to either Denplan Care or Denplan’s Plans for Children. Declined Some practices had already realised that NHS children’s care was not viable and decided to move this group of patients over to private practice. Although made in less than ideal conditions, this decision need not be viewed negatively. Private dentistry for children does work and is a positive move, explains Durham based dentist Diane Riley. For some time she continued to see the children of her Denplan and fee-per-item private patients on the NHS, believing that children have a right to receive free dental care. ‘I felt very strongly that it shouldn’t be necessary for parents to pay for their children’s dental care,’ says Diane, ‘and I did believe that the system would change. However, as time went by, I realised that there wouldn’t be any more money through the NHS and I didn’t want to carry on doing ‘‘dentistry out of the ark’’ for the children.’ She decided to start introducing the idea of private dentistry for children gradually. The practice now offers two plans: a preventive plan for children with no fillings for £9 a month, and a preventive plan for children with fillings for £12 a month. Diane has seen an extremely high take up of her private Plans for Children and feels that, in the long term, with the higher standard of care they are receiving, her young patients will need less treatment. For more information on Denplan please call Hannah Leach on 01962 828194 or 07974 832996. You can also email her on hannah@denplan.co.uk.
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