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Running out of UDAs
6th Feb 2007
Dentistry columnist Michael Watson runs through what is at stake when dentists meet their UDA targets earlier than expected. In December the Sunday Telegraph reported that Anthony Smith, a dentist in Grantham, Lincolnshire, had met his treatment targets early and had ‘been forced to introduce charges for his patients, 2,500 of whom are entitled to free treatment.’ He told the paper that the practice had cancelled all their check-ups and were charging their patients for treatment. ‘When I asked for additional funding, my local trust told me that they did not wish to commission any further services at the present time,’ he was quoted as saying. The Lincolnshire PCT might well ask him why he needs additional funding as they will be continuing to make contract payments to him for the remainder of the year. They may also ask him what the PCT are getting for this money, and why he feels the need to charge patients privately when he is continuing to receive payments from them. Since none of us know the circumstances of this particular case, it would not be proper to comment further on it, but there does arise a general point about what happens when a dentist ‘runs out of UDAs’. From the dentist’s point of view, the position is clear. The PCT commissions a certain number of UDAs; once those are completed the practice has fulfilled its obligations under the contract and, unless further funding is forthcoming, no more NHS work needs to be done. Any UDAs done above the contracted number are, in reality, being done for free and no one should work without being paid. Although the new contract is supposed to have ended fee per item of service, in fact this still exists with four items (bands) rather than 400. The official view is that this is not a correct interpretation of the new contract. A standard GDS contract runs to 158 pages, 384 clauses and four schedules. The UDA requirement is stipulated in clause 77 of the standard contract. The practice is contracted to provide services as stipulated in the other 383 clauses for the duration of the contract, not just to fulfil the annual UDA requirement. As clauses 25 and 41 of the standard contract point out, anyone can ask to be seen under the NHS and you provide services for them by carrying out courses of treatment. The PCT and dentist are also required to agree and write into the contract the ‘normal surgery hours’ of the practice. So how does a practice fulfil its UDA requirement and not be swamped with patients during its normal surgery hours? As explained on page 38 of the book Understanding NHS Dentistry (Len D’Cruz, Raj Rattan, Michael Watson, New Contract Help Publications, 2006), management of the appointment book is the key, whether it is a mixed practice or predominately NHS. ‘You will need to allocate times when you will see NHS and private patients. You should also consider how many patients you can accept for treatment each month and, especially, how many of them need laboratory work. This must be considered in conjunction with the monitoring system.’ In short, it is your responsibility to make sure you do not run out of UDAs because you will have to go on seeing patients whether you have achieved your quota or not. You may need to discuss with your PCT whether they will allocate more UDAs (and more contract value) to you, or whether you should restrict your ‘normal surgery hours’ to those needed to fulfil your quota. At present it appears that, as far as PCTs (and dentists) are concerned, UDAs are the be all and end all of the contract. Last year, however, the NHS provided a GDS Contract Monitoring Toolkit, which runs to over 80 pages and looks at patients seen, level of skills, services provided, clinical governance and quality assurance issues. In future PCTs may well be looking at not just whether you have achieved your UDA quota, but how you have achieved it. They may well be looking at the work pattern and quality of treatment of a dentist who has reached the quota early. Are patients getting a good deal? Are they being offered a full range of treatments, or just the quick and easy option, the extraction rather than the root filling? Are they being told (misleadingly) that new NHS dentistry only allows one filling per course of treatment? Is prevention being included in the services offered? In future the PCT may regard ‘over-achievement’ of UDAs as being worse than ‘under-achievement’. There are sanctions that the PCT can apply; for a start they can vary the number of UDAs without necessarily altering the contract value. So they could increase the UDA requirement for someone who has reached their UDA quota early. They might consider that the contract has been breached and issue a ‘breach notice’, in effect saying ‘don’t do it again’. If you continue to breach the contract, you could lose it.
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