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Thoughts on the upcoming NHS contract

By 10 June, 2019 Members

To date we don’t really know how it will look, so I am basing the following opinions on my experience and history with the NHS over the last 30 years, as well as my history and experience with how government works.

This means my analysis might be flawed, wrong, off base… the writings of a complete basket case in other words.  It will also contain my inherent biases, both known and unrealised.  So of you were to make any future decisions based on what I have to say, it might mean you have rocks in your head :)

In many ways, the new NHS contract will be worse than what we have now.  Worse for associates, worse for patients, worse for staff and worse for the image of the profession as a whole.  It will, somehow, be beneficial to central government and corporates, as well as likely being tolerable to practice owners, especially those with large practices.

Why do I say this?  There is no doubt in my mind that progressive governments have felt that dentistry should be removed from the NHS, but nobody in Whitehall has had the political will or the guts to take that final step.  So they tinker and manipulate the profession, hoping that there will be a mass exodus so that the “greedy dentists” can be blamed for the demise of NHS dental care.  Why there is this reticence confuses me, because it occurs to me that dentistry is hardly a sacred cow that politicians risk sacrificing their careers for.  Likely it is just cowardice, but there might be other reasons that I am not seeing.

The NHS contract has corrupted care in the majority of practices, the dentists delivering that care lowering standards in many cases to try and “get the contract to work”.  I have seen first-hand how the goalposts and the rules were changed, often without the workforce being informed.  Said workforce reacted with fear and compliance rather than risking all by standing up to the general tide of oppression that was thrown over those “lucky” enough to be in possession of an NHS contract.

If you were to ask me, I would state that the NHS was no longer a vessel dentists should consider sailing in, with maybe an exception made for the salaried services.  Working under NHS contract is now filled with suspicion and mistrust, and unfortunately, a lot of that is down to the profession itself.  Some of you may shout your ire at me for that statement, but let me remind you that in the first year of the new contract, the provision of Band 3, single tooth partial acrylic dentures rose by over 70% compared to the years before the contract.  Dentists will make systems work, and often that is by taking whatever lifeline they can find, even though the end of the lifeline is often attached to a bear trap.

I remember in 2007 eating curry with 5 NHS practice owners who were all rejoicing in the way they could make money out of the contract.  None of that conversation, to my recollection, had anything to do with the actual care of patients.  I did my best to avoid such games, but it helped that I was in possession of a relatively high UDA value.  Others weren’t in that situation.  I won’t use the word lucky, because I entered the 2006 contract with a systemised plan.

In a time when the country is close to bankruptcy (the UK national debt grows by the rate of £5170 per second) is it any wonder provider and performer activity is being scrutinised under the most powerful of accounting microscopes.  We created a rod for our own back, and we did it willingly.

Here is what I predict will happen with the new contract

  • There will be a grace period as practitioners are allowed to adjust.  Flaws and loopholes will be found that will be exploited by dentists trying to keep their practice viable.  These will quickly be closed down, as the mechanism for oversight and monitoring will likely be maintained by NHS England (instead of being closed down as happened in 2006).

  • The % paid to associates will come under pressure.  I also feel the wording of the contract will further hamper the ability of NHS associates to claim self-employed status.  The NHS is heading for an employee model for non-practice owning dentists.

  • There will be vastly greater amounts of paperwork associated with the new contract.

  • Dentists will realise that really they should leave for the private sector, but too many of them will cling on for reasons only known to themselves.

  • The contract delivered will be inadequate and completely the wrong mechanism for delivering dental care to the population.

  • Workforce numbers will continue to fall and it will be increasingly difficult to fill positions as the younger generation of dentists realise their future is outside the NHS

  • The contract will be designed to be beneficial to corporates, but their own shabby business practices will see them destroy that perceived benefit

  • The contracts will be time-limited 

  • The new new contract will ultimately fail

If you presently own or work under an NHS contract, you might want to do your own risk analysis.  Whilst I have no connection with Practice Plan, an organisation like this might be a suitable mechanism for NHS practice owners to transition into the light.