Survival of the fittest
As the Department of Health’s juggernaut careers towards the start of the new dentists’ ‘contrick’ there is still a major issue of which dentists considering signing this contract need to be aware. Some could argue that it is a fantastically clever way to get dentists to sign over the entire goodwill value of their businesses to their primary care trust (PCT) for free – in other words, to give their businesses away.
Signing the new contract will turn a dentist into little more than a salaried practitioner, yet one who is still responsible for their business risk, and with far reduced potential reward. By awarding a fixed-price contract to each practice or provider, the PCT is, in effect, capping its spend in that practice, unlike the present system which, although also patently flawed, can vary according to output.
But now dentists who sign the new contract will have to prove they can produce a certain number of Units of Dental Activity (UDAs). This will involve a detailed audit of what these dentists do, and woe betide those who do not keep up. They will have to open up their practices to more in-depth inspection, and will be on no less of a treadmill than before. And what happens to those practices that achieve their UDAs earlier in the financial year? Will there be funds to raise their UDAs to fill their ‘spare time’? It’s unlikely.
And how will patients feel when they are told there is no money left in the system, and that they need to wait until next April for their treatment? What happens if the PCT runs out of money before the end of the year? Is it really inconceivable that there may not be enough money to pay dentists when a PCT overspends? If wards in high-profile hospitals can close in cases of overspend, then dentistry, as the poor relation, will fare no better.
The real threats to goodwill and business value already exist, but I expect this to get a lot worse under the new system. Can dentists be certain their UDA value will cover their costs? Has anyone made the calculations? Will the UDA value cover the costs of more expensive and effective materials, and ever-increasing lab bills? I have heard of UDA values as low as £11 per unit. What happens when a dentist discovers their UDA value is too low for all these things?
If the PCT will not provide extra funding, as the evidence already shows, what choices do dentists have? None – they must remain as they are, knowing they cannot move with the times in this so-called caring profession. Nor can they develop their businesses because they are no longer in control of them. Who would want to buy a business in this situation, particularly when there is no guarantee that the PCT will give the new owner a contract?
At least the present system offers choices. A dentist can reduce reliance on the NHS by various means. They can close the NHS list, restrict it to exempt groups or child-only lists, or build up their private treatment business by persuading existing patients to accept more private options. All these are valid choices, and they at least allow the dentist to try to improve their situation.
In the new system, this choice is gone. We are seeing PCTs trying to bully dentists into doing ‘all or nothing’. Some practices are being told that if they do not accept the contract as proposed, they will be offered no contract at all, and their ‘contract value’ will be given to someone else in the area, or perhaps to one of the corporate bodies now jumping on the NHS bandwagon.
Some politicians have also jumped on that bandwagon to score some cheap political points at the expense of dentists. They have absolutely lambasted some of our colleagues who have been brave enough to make the move to independence, usually after much soul searching.
For example, one MP called for a boycott of a surgery that was converting, and called on the government to compel the dentists involved to pay back to the community the cost of their training. Other MPs have also made scurrilous and ill-informed attacks on dentists, and are also calling for people to boycott their practices.
Does this mean, then, that law graduates must work only on Legal Aid cases, or that teachers who become politicians must repay the cost of their training? Why are they allowed to work in the private sector but dentists, it seems, are not? Why not ask us to boycott certain petrol stations because of an increase in the price of fuel, or supermarkets over the cost of food?
These politicians then say that hundreds of thousands of pounds have been earmarked for new centres in affected areas, that they will be fully staffed with dentists, nurses and auxiliaries, and will provide NHS dentistry for all who want it when they want it. But where is all this money coming from? And the nurses, dentists and auxiliaries? I (like others) offer salaries, terms and conditions far above NHS levels, yet we are still finding it difficult to recruit competent and communicating dentists to man our facilities.
The politicians are quoting outrageously inflated earnings figures for dentists, in their determination to paint us as greedy and grasping. But I know of many instances in which colleagues have approached their MP, as a last resort, to ask for help to enable them to continue running their practices. Some were not even given the courtesy of a reply and the rest were simply fobbed off with empty promises.
I have watched colleagues walk away from their practices because they could not carry the burden of debt any longer, and could not find buyers – a fine reward for their loyalty and commitment over the years. And those who were brave enough to become independent when no help was forthcoming, were given a roasting in the press from the very MPs who chose to ignore their pleas for help.
Dentists have been made the scapegoat for inadequate funding, and MPs have been happy to foster the notion that dentists are responsible for the crisis in NHS dentistry. It is time they looked at their own failings – after all, it is the Government that is responsible for providing adequately funded NHS dentistry, not dentists.
Things are little better in Scotland. With its hard line on criteria for commitment payments and access practices, the Scottish Executive has made it clear that it wants to ‘sort out’ dentists. It is also trying to force dentists back into the NHS. But why would a dentist choose to go back to trying to run a business according to the whims and fancies of the current government?
Politicians, in general, treat us with contempt, and show a complete lack of understanding of how the system works. How many more broken promises and agreements, and how much mismanagement of PCTs will it take for us to realise that it is time to get out, to take control of our businesses, and practice the dentistry we were trained to do?
I have long since decided that enough is enough, and I am here to support those who need help to take back control of their lives and finances. If there is enough will and courage out there, we can achieve this simple business aim.
April Fools’ Day signalled the beginning of the end for NHS dentistry. Those who stay in NHS arrangements will, in effect, become salaried employees of the state, with no independence, and yet none of the benefits of being an employee. The new contract is nothing more than diabolical manipulation on behalf of the Government to get all our goodwill for nothing. I would go so far as to call it extortion.
If you feel you have a business worth fighting for, now is the time to do something about it. It is essential, if you wish it to thrive, that you protect your independence and add value to your business by establishing a regular income stream of your own, which is not under the control of the Government or career civil servants with no knowledge or experience of running a business. It is said that everyone has a pain threshold and everyone has a breaking point. Have you reached yours?
The views expressed in this article are my own, but are shared by a growing number of like-minded colleagues.
John Barry BDS is the chief executive of Isoplan International, www.Isoplan.co.uk, and can be contacted at [email protected]