One of the array of measures that came into force on 01 March 2024 announced in the then government’s paper “Faster, simpler and fairer” was the New Patient Premium (NPP). This initiative provides an additional payment of either £15 or £50 to a practice for each patient depending on their treatment need who has not been seen in that practice for at least two years. At present it is running until the end of March 2025.
We have long argued that what is needed is not a scattergun approach to access that would do little to support the legal obligations of Integrated Care Systems to reduce health inequalities or improve health outcomes, but instead an approach which drives integration with the rest of the health and social care sector. Indeed, the conditions for using the New Patient Premium excluded involvement in local initiatives.
As well as not supporting the drive for integration of dental services with the rest of the health and social care sector, the proposal did not provide any new funding. The result is that existing contract values are being used to fund the New Patient Premium. The inevitable result of this is that the NHS dental budget will be used up faster but access appears to be dropping, with those at high risk still unable to get an appointment on the NHS. Furthermore, the drive to develop new ways of working at the local level has also been hampered by the unstable financial position the New Patient Premium has created for Integrated Care Boards.
We have anecdotal evidence that the application of the New Patient Premium is leading some practices to use their UDA allocation faster than in previous years and that the amount of predicted underspend will be severely reduced as a result. In previous years contracts have been permitted to over deliver their contracts by 10 per cent. But this year, because practices are more likely to achieve their contracted activity this has been reduced to the usual contract allowance of two per cent.
The concern is that if more capacity for NHS dental treatment is not forthcoming, some dentists will be left with no other option than to seek work outside the NHS dental service. Once dentists start working in private healthcare settings, we know it is extremely difficult to entice them back to working within the NHS.
We now have a different government, which had previously indicated a desire to work with the profession to provide a decent NHS dental service to our communities.
The big question remains to be answered, however: will the new government change direction, and give more autonomy for contract variation to the local level to support targeted initiatives which support integration and reduce health inequalities? Or, will they continue with an initiative which reduces access, drives dentists out of the NHS and is not coordinated with any goals that the rest of the health service is trying to achieve?
Hopefully colleagues read the message from the NHS BSA in their recent newsletter about the NHS England evaluation of the impact of the New Patient Premium. I hope that many of you registered and were able to provide feedback on your experiences. It’s only through active participation with a loud voice that we can drive the changes we and our patients need in order to improve or, dare I say it, rescue the provision of an NHS dental service.
I therefore look forward to the findings of the review of the New Patient Premium and, in particular, to the next steps from the new Government.