On 07 February the Government released its long awaited dental recovery plan. The plan has lots of headline points about increasing the average UDA value, access payments, water fluoridation, consulting on a tie in for dental graduates and on contract reform, but it lacks specifics. It is not clear how the proposals add to the existing powers of Integrated Care Systems or indeed where exactly the funding is coming from.
Integrated Care Boards already have the power to uprate UDA values and apply contract values flexibly. The plan talks of ringfencing the dental budget. Indeed the dental budget is already ringfenced in the sense that it is contractually committed. The end of the ring fence occurs only when and if a practice doesn’t deliver that contract in that year. The LDCs in the LDC Confederation are working with their Integrated Care Boards to develop plans using flexible commissioning to ensure that there is no underdelivery of contracts, but that all dental funding is used in year by the practices which have those contracts. The commitment of “ringfencing” the dental budget is, to providers and patients, meaningless.
The plan outlines intentions to make it easier to recruit dentists from overseas, but this fails to address fundamental recruitment issues within the dental profession. There are probably enough dentists in England, but they do not want to work under NHS contracts, or if they do, do not want to work under them full time. Simply importing a workforce which will then find more favourable employment in the private dental market does not address the fundamental issues around how the NHS contract operates. The proposal to consult on a tie in for dental graduates is interesting. It was mentioned by Rachael Maskell MP at the 2023 LDC Conference where it was soundly rejected by delegates. Nor does the proposal to increase skillmix or the engagement of dental hygienists and therapists. Unless these professionals have access to NHS benefits and the ability to earn as much under an NHS contract as they would privately the proposal is meaningless.
By the far the most headline grabbing statement made is the potential access payment for new patients, and the £20,000 golden hello to dentists working in areas with low access. It is unclear to whom the access payment will go, the practice or the performer and how this will be enforced. It is also unclear how the access payment will help a practice meet its contractual obligations. What it does make clear is that the Government agrees that the UDA system is not sensitive enough to meet the needs of the population. The golden hello will no doubt be very welcome, where there are still practices in existence in areas designated “dental deserts”.
While many of the proposals are in themselves positive, they do not in actual fact represent much that is new. The GDC was already working to improve the overseas registration exam, ICBs are already engaged in flexible commissioning as discussed at last year’s LDC Officials’ Day, most Local Care Partnerships and Local Authorities are already implementing family hubs which have as part of their service specification oral health.
But perhaps the most interesting, and only new, commitment made in the document, and the one which could have the furthest reaching consequences is this:
“To reduce unnecessary bureaucratic burdens for the profession and enhance patient experience, we will establish and work with a new stakeholder reference group for dentistry and oral health to identify the changes that would make the greatest difference to practices providing NHS care and their patients.”
We routinely hear that bureaucracy is indeed a major issue affecting the morale and motivation of the profession in the NHS. It is interesting to see in the same document, however, that rather than remove the pointless and duplicatory Performers’ List , that the proposal is simply that it will look at only whether it “can be streamlined further”. It remains to be seen whether LDCs, the voice of those working at the frontline on NHS dental care will be invited to join this steering group. We have contacted the Department of Health and Social Care to ask and await a reply.
Instead the most important element is, as ever, the issue which was not addressed: patient charges. There is no proposal made which actually removes barriers to access for patients. Instead it is likely that at the same time as these proposals come in that patient charges for NHS dentistry will increase, thereby increasing barriers to access for those who need care most. Nor is it clear if these proposals are funded by new money (despite the Health Secretary’s insistence) or whether all the proposals will be funded from the existing dental budget. A budget which at its best only ever provided access to around 50 per cent of the population.
So what does it mean for LDCs and the engagement with Integrated Care Boards? Not a lot.