The idea of time-limited contracts was proposed by the Government two years ago as a way of improving market competition and efficiency. A source of much debate since then, we asked Judith Husband, who has first-hand experience of working within a time-limited contract, for her thoughts on the question:
There has been much discussion, and some consternation, surrounding the potential introduction of time-limited NHS contracts for general dental services. Some of us have direct experience of time-limited contracts, usually for advanced mandatory services, my own prison contracts were all PDS time-limited.
It is always helpful to understand the history and context of proposals in order to frame the future possibilities. We trace the origin of this current debate to November 2015. A very different world pre-referendum, David Cameron at the helm with George Osborne by his side as Chancellor of the Exchequer. The Chancellor announced the launch of “A Better Deal: Boosting Competition to Bring Down Bills for Families and Firms”. Within this “better deal” was noted the intention to introduce time-limited dental contracts together with an action plan to raise living standards and create competitive business conditions across many sectors.
This proposal for dentistry was not entirely new, it built on the findings of the 2012 Office of Fair Trading (OFT) report on dentistry. It articulated the Cameron government’s commitment to dental contract reform and to “carefully considering the use of non-time-limited dental contracts as part of broader work on contract reform.” The 2012 OFT report noted the NHS dental market (in England) was subject to rigid regulatory controls over who could enter and their location – concluding this limited innovation and ultimately patient choice. One can assume the Government felt this also presented a clear opportunity to drive forward efficiency from greater competition in the provision of dentistry. And so, two years on from “A better deal” we have over half a billion pounds of dental contract tenders now live in orthodontics. It is safe to say that NASDAL appear to have been very close to the mark in their assessment of time-limited contracts back in 2015 stating HM Treasury’s announcement amounted to a “Corporates’ Charter”.
“I believe we will have a gradual introduction of contracts including clearly defined timeframes within them. Regional variation is likely to remain with some commissioners innovating, others not so.”
First-hand experience has taught me the immense personal and organisational challenges of independently tendering and also attempting to form consortia – it’s far from simple. The BDA have recently initiated legal proceedings against NHS England with respect to the tendering process in orthodontics. With BDA Chair of General Dental Practice Henrik Overgaard-Nielsen saying, “We will not let NHS England load the dice in favour of larger providers and jeopardise the livelihoods of hundreds of our members.”
We can all scope out the challenges of financing, NHS practice value, complex and traumatic staff TUPE processes. Huge risks for associates with their self-employed status, instability to patient care and a potentially damaging loss of access with private conversions should the model be the traditional three plus two-year contracts. In my discussions with the CDO England it is apparent we need to think in much broader terms, perhaps look at other contracting examples with significantly longer timeframes. A change such as this would completely destabilise the market if enacted en masse but a gradual roll-out of such contract amendments could be undertaken. We already know there will not be a “Big Bang” in contract reform.
The Department of Health have placed some responsibility on the European Union procurement legislation for these potential commissioning changes. I would caution any early celebration in view of the Repeal Bill. In a bid to ensure a “calm and orderly exit” all existing EU legislation will become UK law. It is widely recognised there will not be time for Parliament to scrutinise every change, so ministers will have wide powers to make changes by secondary legislation. You may feel this is an opportunity, it certainly alerts us all to the need for vigilance during a tumultuous period in UK history.
On balance, I believe we will have a gradual introduction of contracts including clearly defined timeframes within them. Regional variation is likely to remain with some commissioners innovating, others not so. All this assumes the broader political and economic backdrop remains generally similar to now – during these uncertain times future-proofing our businesses has never been more challenging. Private or NHS, the need to be well informed and alert to the potentially rapid pace of change has never been greater.