Local Dental Committees showing the way forward on contract reform
Early drafts of the alternative contract were produced by a small group of practitioners working with the LDC chairs of Hull and East Yorkshire, North Yorkshire and South Humber LDC’s and the Area Local Dental Network.
The group built on the Department of Health’s consultation exercise in the summer and the experience of those who have been piloting change.
On the positive side they found that the care pathway approach, with its emphasis on prevention, had received universal support from the profession.
The alternative contract proposes a ‘blended’ system of remuneration.
The contract value would have three elements: access (40%), activity (45%) and quality (15%).
Each practice would maintain a list of its registered patients, who attend on a regular basis.
The ‘access’ payment would be paid in respect of these and would cover oral health assessments and prevention.
Even though most dentists would like to see the back of Units of Dental Activity (UDAs), realistically there will need to be some kind of measurement of ‘activity’ and for the foreseeable future this is likely to be UDAs.
The alternative contract proposes increasing the number of bands making the system more sensitive and fair, by rewarding more complex courses of treatment.
The additional bands should enable targets to be reached more easily providing more time to provide quality.
The alternative contract proposal also proposes a different, more sensitive way of commissioning dentistry.
For instance, by top slicing contract value and using this money to commission specialist services in primary care, for example oral surgery or restorative dentistry.
This system would support a network of specialists and dentists with a special interest (DwSI) integrated within a system with a consultant at the centre.
It would also provide education, both improving the competence of general dental practitioners who are not confident at certain procedures and also others who wish to enhance their skills.
The quality section was developed around characteristics of good practice.
The quality section must be a lever to improve rather than a stick to beat practices with.
The parameters must be very realistic and easily achievable.
The alternative contract has been now sent to all LDCs in England and Wales and many have responded with positive suggestions.
Presentations have also been made to the Department of Health and Association of Dental Groups.
It will be presented to and discussed by the British Dental Association’s General Dental Practice Committee at their next meeting on 10 October.