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BDA calls to scrap UDAs
2nd Apr 2007
Peter Ward, left, with Niall Dickson who chaired the conference
The British Dental Association has hit out at the government’s reliance on Units of Dental Activity as the only means of measuring performance under the new contract. It is calling for an urgent reform of the system, branding it ‘crude’ and ‘counterproductive’. The demand for change formed the key message of last week’s BDA’s conference, Dentistry: The Way Forward, where it argued that the new contract has failed against its own criteria for success. The Association claims that the new contract is stopping NHS dentistry concentrating on patient care, and turning it into a target-driven system. ‘Simply put, the UDA is far too blunt an instrument,’ said Peter Ward, chief executive of the BDA. He stressed that performance needs to be measured against a ‘basket of indicators’ if the reforms are to achieve their aims and avoid disillusioning the profession. Results from a BDA survey indicate that 85% of UK dentists feel the new contract has failed to improve patient access to NHS dental services. Over 90% of the respondents feel it has not allowed them to develop a more preventive approach to care, while 97% did not think it had removed dentists from the ‘drill and fill’ treadmill. Dr Ward added: ‘I have never seen statistics as profound as this . . . we ignore this message at our peril’. The event heard from John Milne, a practising GDP in Wakefield, who agreed with many of the survey’s findings. He explained that the pressure of keeping on top of UDAs prevents him from carrying out preventive work with patients that the contract is supposed to encourage. ‘The contract does nothing to improve oral health’, he told attendees. He argued that the pressure of trying to meet a UDA quota can adversely affect the choice of treatment, and asked the question: ‘Is this the way an honourable profession should be thinking? I don’t think so.’ Susie Sanderson, chair of the BDA executive board, said: ‘The new contract not only fails to recognise and reward prevention, but has in fact lead to its undoing. ‘Contractual performance has to be monitored but UDAs are only a single and very crude method. We need a more sophisticated approach which is sensitive to the reality of delivering dental care to patients and which supports preventive care, rather than works against it.’ Chief Dental Officer for England Barry Cockcroft defended the contract but accepted that there was some way to go. ‘These changes come to a system that has been steadily declining for the past 20 years,’ he said, pointing to the rise in the number of practices accepting new patients as proof that this decline is at least being arrested. Although the UDA has become the currency of the new contract, PCTs are not in fact required to base contract values on it alone. Referring to a letter in which he reminds PCTs of this, Dr Cockcroft said: ‘An unintended result of the contract is that PCTs are using UDAs for salaries or contract values’. However, he offered no promises that PCTs would be expressly instructed to consider other indicators in future. When questioned as to whether practices facing a ‘clawback’ of funds for failure to complete their UDAs could avoid so by showing proof of working to other criteria, the CDO declined to accept responsibility, repeating that it was a decision for the individual PCTs to make. The CDO’s assurances that the profession will be more settled in another 12 months fell on deaf ears. John Renshaw, representing focus group Challenge, rebuked these claims, saying: ‘You’re living in a parallel universe, and it’s time you joined the rest of us in the real world.’ Kevin Lewis, another speaker on the panel, added his own note of caution to Dr Cockcroft’s assurances. ‘Widening the scope of contract value beyond UDAs is not the currency that finance directors deal in,’ he said. ‘History tells us that once you lose a dentist to private practice, it takes wild horses to drag them back – if they come back at all.’
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