Plenty has been heard about the state of NHS dentistry in England, but what are things like in the other UK nations? Here Practice Plan regional support manager – and proud Welsh woman – Louise Anderson explains how the land lies in her home country.
There is considerable unrest among Welsh NHS dentists. Although they have been awarded a contract uplift of 6%, a conservative estimate of the increase in costs for dental practices is between 10% and 15%. This means that 6% is a real term pay decrease leaving practices unable to plan for future expenditure.
The uplift also comes with conditions attached which are causing a stir at the moment. The first condition is that the antimicrobial audit, last completed in 2023/24 and the results of which were used to improve the prescribing of antibiotics, must be undertaken again, and must be completed by the end of June 2025.
The issue with this is that previously funding was available for practices to complete this audit, but now they are obliged to cover this cost in order to be able to receive the 6% uplift. Yet again, this diminishes the real terms value of the uplift.
Digital portal for waiting lists
Another issue which is causing consternation is the requirement that all practice-held waiting lists should be transferred to a dental access portal. This will go live from June 2025. Previously dental practices were able to hold their own waiting lists. This allowed practices to treat people local to the area and the dental practice.
Practices are now being asked to hand over those waiting lists to a dental portal. This will create a centralised waiting list, and patients will be allocated to practices from that list. This means practices face having patients allocated from far and wide, regardless of area, and will have no control over the new patients they are being asked to take on.
However, as a Practice Plan customer told me recently, it was unlikely they would be able to utilise or support the portal as they simply don’t have the capacity for an NHS dentist to see anyone through the emergency access route.
On the bright side, there will be some additional funding available for practices using the portal. For every patient seen via this route practices will receive £100. If they fail to attend, then the practice will receive £50. On the face of it, this sounds like easy money and a way of increasing revenue for the business. In reality that’s unlikely to be the case.
To be able to gain access to this additional funding practices face the genuine practical problem of how to carve up their appointment book to fit in these patients. Diary planning and zoning will become supremely difficult as there will now be the need to accommodate historic patients, new patients, fluoride varnish clinics, as well as providing health board allocated access sessions.
Excessive bureaucracy
This will add to the punishing level of bureaucracy to which NHS contract holders find themselves subjected. Unlike the English system of payment via UDAs delivered, or the Scottish SDR, in Wales dentists are measured against a series of metrics. Practices are paid their contract value based on metrics weighted by percentage values. If all metrics are achieved, then the full contract value will be paid.
In this case, UDAs still represent 25% of the contract value, however there are also metrics for historic patients, new patients and urgent access patients. Fluoride varnish applications are also part of the equation. This makes life very complicated for NHS providers.
On a recent visit a practice manager told me that she spends 70% of her time managing the NHS contract for just 25% of the practice’s income. That told me only 25% of the practice’s income came from an NHS contract which meant the majority (75%) was being achieved through fee per item and membership plan patients. Clearly, it was the NHS contract that was making disproportionate demands on the time of the practice manager as the practice tries to achieve its target.
The system is so complicated that I have even visited practices who have a board in the practice manager’s office labelled ‘historic patients’, ‘new patients’, ‘access patients’, ‘fluoride varnish applied’, and as the patients come in, staff mark off a daily tally to assess whether they’re hitting their metrics. Clearly, comprehending how to break down the figures to ascertain how many of each type of patient is needed to achieve their target is extremely difficult for practices.
Unreliable data
Another issue facing NHS contract holders is that eDen [Welsh digital NHS contract management information system] is not always up to date. Data is not real time and so cannot be relied upon to be accurate. Also, as was the case last year, dental practices do not receive their year-end reports until much later in the year. This leaves practices unaware of whether they have hit their targets or whether they will be subject to any clawback. All of which makes keeping track of things a very difficult task.
My advice to practice managers grappling with these new conditions is to first look at your contract value and break it down into the metrics and the relevant percentages. I would then suggest reviewing your patient base, and with reference to your ACORN (Assessment of Clinical Oral Risks and Needs) forms identify patients where you can extend their recall time to create space in your appointment diary for emergency patients allocated via the portal. Diary zoning will be essential to keep track of which patients are being allocated to the metrics that you’re trying to hit during your surgery hours.
Meticulous planning will be the key to success with these new measures. Ensuring there are sufficient slots within the diary to be able to achieve the targets practices have been set is fundamental. However, to achieve this teams may also need to prepare themselves for some difficult conversations with patients about extended recall intervals.
This year, Practice Plan celebrates 30 years of welcoming practices into the family, helping them to grow profitable and sustainable businesses through the introduction of practice-branded membership plans.
If you’re considering your options away from the NHS and are looking for a plan provider who will hold your hand through the process at a pace that’s right for you, you can start the conversation with Practice Plan today by calling 01691 684165 or to book your one-to-one NHS to private conversation at a date and time that suits you, just visit practiceplan.co.uk/nhsvirtual.
If you’d like to find out more about introducing a plan, and how Practice Plan can help you, visit practiceplan.co.uk/nhs.
