Reforms to the NHS Dentistry Contract 'not a final destination', says the BDA

The Government’s commitment this week to reform the NHS Dentistry Contract in England ‘lacks urgency and ambition’ and fails to provide adequate funding to truly deliver its aims, the British Dental Association (BDA) said today.

This week ministers agreed to proceed with the implementation of proposed changes to the contract, with some modifications reflecting feedback from a public consultation support a focus on the highest-priority patient groups, deliver important and evidence-based prevention activity, and introduce a quality-related element for the first time.

However, the BDA fears they will not go far enough to bring about widespread improvements for patients or to properly reward dental practitioners for delivering NHS services.

Commenting on the announcement, the BDA said: “We hope that interim changes to the discredited NHS dental contract will offer a boost for patients and practitioners, but this is not the wholesale change required to save the struggling NHS dental service.

“We have been working hard to influence this package for some years and will continue to demand clarity over several important areas of ambiguity.

“The changes to the 2006 contract include a new time-limited ‘care pathway’ for higher-needs patients that is set to provide fairer pay for more-clinically-complex cases, which are typically under remunerated, or even delivered at a loss under this contract.

“The proposals act on our calls for dentists to be paid for activity that helps prevent oral disease and decay.

We hope that interim changes to the discredited NHS dental contract will offer a boost for patients and practitioners, but this is not the wholesale change required to save the struggling NHS dental service

“They also introduce new payments to support clinical audits and peer reviews at practice level to help improve quality, and mandate practices to provide a level of urgent care, at an improved rate.

“But, as we all know, a decisive break from Units of Dental Activity remains key, and these changes do not constitute a final destination for NHS dentistry in England.

“We need a response proportionate to the challenges we face.”

The BDA says the new Adult Oral Health Survey reveals decay rates among adults have surged to levels not seen since the 1990s, with decades of oral health gains wiped out.

It states that more than four in 10 people (41%) had obvious signs of rotten teeth when examined, up from 28% in 2009 and similar to levels in 1998 – tracking the cumulative impact of austerity and the failed dental contract which was imposed in 2006.

The dental budget has remained effectively static in cash terms since the onset of the coalition Government, with savage real-terms cuts leaving the typical practice delivering routine NHS treatments like checkups or dentures at a financial loss

“The nation’s oral health gap will only widen unless the Government offers urgency and ambition,” the BDA said, as it called for adequate funding to deliver the improvements.

“This package has no new money behind it,” it states.

“We have stressed that the success of longer-term reform will hinge on adequate investment, both to ensure the financial sustainability of dental practices, and to restore care to millions.

“The dental budget has remained effectively static in cash terms since the onset of the coalition Government, with savage real-terms cuts leaving the typical practice delivering routine NHS treatments like checkups or dentures at a financial loss.”

General Dental Practice Committee chair, Shiv Pabary, added: “We do hope changes can make things easier for practices and patients in the interim, but this cannot be the end of road.

A decisive break from Units of Dental Activity remains key, and these changes do not constitute a final destination for NHS dentistry in England

“We need a response proportionate to the challenges we face, to give NHS dentistry a sustainable future.”

The BDA is planning a free webinar on 15 January to enable dental practitioners to raise questions on the changes, which the Government said this week would be implemented from April next year.

Under the plans, which apply only in England, the contract will:

• Mandate a proportion of contract capacity to be directed to unscheduled care, supported by new payment arrangements and in line with a national service specification
• Create new long-term and planned pathways with improved payments to support care and treatment for patients with significant dental decay and/or significant gum disease
• Create a new course of treatment for the application of fluoride varnish on children, without a full dental check-up and which can be applied by extended duty dental nurses (EDDNs) between full check-ups
• Incentivise greater use of resin-based fissure sealants in children’s permanent molar teeth by re-banding the treatment from band 1 to band 2 to reflect better the time and cost associated with this treatment
• Introduce a new band 2 sub-band for denture modifications, relining, and repairs
• Options to support reducing clinically-unnecessary check-ups
• Introduce funded quality-improvement activities for practices
• Provide practices with funding for annual appraisals for associate dentists, dental therapists, and dental hygienists who provide clinical NHS care
• Develop minimum terms of engagement set out in an NHS model contract for dental associates
• Extend minimum requirements of NHS service for discretionary support payments to include all NHS services, not just time on the dental Performers List
• Develop an NHS handbook for dental teams

Taken together, the proposals seek to:

• Secure delivery of the Government’s commitment to provide 700,000 additional urgent dental appointments and ensure a safety net is in place to allow any patient with an unscheduled care need to get rapid support on the NHS
• Introduce new clinical and payment pathways to improve care for patients with complex care needs
• Incentivise more-evidence-based interventions including through greater use of dental professional skill mix
• Improve the focus of the quality of care which is delivered
• Help dental professionals to feel part of the NHS

In its report outlining the changes and following the public consultation, Jason Wong, chief dental officer for England, said: “The NHS dental contract quality and payment reforms represent a significant and essential step on the journey to improve and transform access to, and quality of, NHS dentistry, delivering care that meets the diverse oral health needs of people across England. 

“We embarked on a journey with the initial set of reforms in 2022, the most important of which was the expansion of band 2 interventions to support the delivery of preventative care and stabilisation to those requiring treatment on 3 or more teeth. 

“This began a process where we were able to address the clear feedback from the profession that the contract was getting in the way of allowing them to treat the diverse needs of people presenting for care across the country.

“This package confirms our continued commitment to that principle.

These proposals are not the end of the reform in dentistry, but getting quality and treatment right is a necessary step to underpin any future, more-fundamental, reforms

“It allows us to go much further in responding to the concerns of dentists and dental teams with further incentives to support preventative care and oral health stabilisation, and to help professionals deliver the good quality, evidence-based care that motivated them to become clinicians in the first place.

“To ensure fairness, the system needs a complex care pathway that effectively uses the clinical expertise of dental and oral health teams.

“This is an important step in formulating clinical pathways founded in a strong evidence base, enhancing longitudinal care for patients experiencing unmanaged caries (tooth decay) and periodontal (gum) disease.

“These are patients who often present within the unscheduled care system or struggle to access routine care.

“These proposals are not the end of the reform in dentistry, but getting quality and treatment right is a necessary step to underpin any future, more-fundamental, reforms.

“By uniting sound clinical philosophy with contractual reform, we will have established the essential partnership that we will need to continue to improve the dental system, given the very real challenges ahead.”