Prototype feedback

Does the prototype feedback offer optimism for the future?

Nigel Jones NHS Confidence Monitor - Industry comments, NHS Dental Landscape Leave a Comment

The latest results from the NHS Confidence Monitor survey revealed deep unhappiness among dentists in the NHS, and that the majority are considering leaving. Similarly, research carried out by the BDA found comparable results.

In light of this, I met Eddie Crouch, vice-chair of the BDA’s Principal Executive Committee, to discuss whether contract reform and the experience of those in the prototypes offers any hope of alleviating these feelings and instilling more confidence about the future of NHS dentistry.

Eddie had recently been to an event with owners of practices involved in the prototype programme. Whilst some of those did have positive comments, particularly around the preventive approach, others talked about the challenges they faced in terms of how much time, effort and money they had to invest to make the model work.

For example, one practice had spent £50,000 in order to recruit another dentist so that they could deliver the contract. Eddie said, “That amount doesn’t take into account how many extra hours they had to open or how staff wages might have been affected, so the actual cost would be even higher.

I’m really concerned that the model being developed simply isn’t that scalable. For those still working in the existing contract and hoping that reform will deliver something better, that doesn’t look to be on the horizon and the optimism that was there seems to be ever decreasing. This isn’t going to help the morale of the profession in any way.”

“I’m really concerned that the model being developed simply isn’t that scalable. For those still working in the existing contract and hoping that reform will deliver something better, that doesn’t look to be on the horizon and the optimism that was there seems to be ever decreasing.”

This is similar to the feedback, albeit unofficial as we await the results of the evaluation reports, that I have heard from some of those testing the prototype contracts. Whilst they welcome the new clinical pathway, they have seen an increase in running costs to implement it whilst still achieving the access and activity targets, which impacts their practice’s profitability.

The main driver, and an indicator of success, of the prototypes is improving access for patients. Indeed, Eddie pointed out that recently Steve Brine MP, Parliamentary Under Secretary of State for Health, said that the new contract would only be rolled out once it was proven that access could be maintained or improved.

However Eddie also noted, “We are a mile away from doing that. A third of the people taken into the prototypes, who are real advocates of making this system work, are failing. If it’s failing in the real advocates once you roll this out over 8,000 practices in England, there is going to be a huge number that struggle with the business model, are and not able to survive, which would have a real detrimental effect on access.”

“The main driver, and an indicator of success, of the prototypes is improving access for patients. Indeed, Eddie pointed out that recently Steve Brine MP, Parliamentary Under Secretary of State for Health, said that the new contract would only be rolled out once it was proven that access could be maintained or improved.”

Contract reform was instigated after the existing contract was deemed unfit for purpose in 2007, and yet it doesn’t feel like dentists are in a better position now, more than 10 years later. Given this lack of progress, and the difficulties within the prototypes that appear at least in some cases to be exacerbating the issues they were trying to solve, I asked Eddie what timescale he thought there now existed for reform.

“A really worrying thing that I heard at a prototype evaluation meeting was that they don’t intend to make major changes to what’s going on at the moment,” said Eddie. “I think the default position has always been that, if it doesn’t work, we’ll stick with what we’ve got.

I question why they would be inclined to actually change what they have got which, at the moment, is a decrease in spend on dentistry, an increase in patient charge elements, and no access problems across the country. The contract might not be working for us in the profession, but it’s certainly working for some people, and that’s the commissioners.”

The discussion between myself and Eddie was recorded and is available to listen to in full as a podcast.