Next steps to support the recovery of NHS dentistry



Classification: Official

Publications approval reference: C1425

To: All NHS primary care dental contract holders

30 September 2021

Dear colleagues,

The last year and a half has been an extraordinarily tough time for the NHS, however thanks to the hard work of NHS staff, services are recovering and starting to tackle the backlog of care.

The priority has to be to increase access and recover activity and action must be taken to improve this.

As such, the NHS plans to support the recovery of dental services for patients by:

  1. Set contractual arrangements that safely maximise access and activity.
  2. Supporting NHS dental contract holders and the wider dental team.
  3. Continuing clinical prioritisation of patients such as those with urgent need and children.
  4. Proceeding with dental system reform.

Contractual requirements that safely maximise access and activity

Since we began the journey of the recovery of NHS dentistry, our dental teams have worked hard to deliver, and we are grateful for their dedication to NHS patients.

In August 2021, mean performance was 70%, and 63% of contractors are anticipated to achieve or exceed 60% of their contracted Units of Dental Activity (UDAs). Many contractors are comfortably exceeding the threshold.

This impressive rate of delivery shows the ability of practices to adapt to the new environment and this determination and hard work by dental teams is helping to improve patient access. We must now proceed to set thresholds which maximise safe patient activity and access. In determining these requirements, we have sought to balance maintaining clinician and patient safety, fairness to contractors and the urgent need to maintain and increase access for patients, who are struggling to access care.

IPC guidance is being reviewed and stakeholders are being engaged on its contents. This work is being led by the UK IPC Cell (made up of devolved and central government bodies). We have concluded we are only able to set contractual priorities for the next quarter as we need to retain the ability to respond to any revision of IPC requirements over the next few months. Therefore, contracts will continue to be in place for 100% of normal volumes, and it will continue to be a requirement that all NHS funded capacity is used to deliver the maximum possible volume of safe care for patients.

There will be ongoing contractual protection for practices unable to deliver their full contractual activity between October and December 2021. During this period clawback will not be applied to practices delivering at least 65% of contracted UDAs and 85% of contracted Units of Orthodontic Activity (UOAs).

The rate of clawback will then reduce linearly down to a lower threshold of 52% of UDAs and 60% of UOAs. Below these levels normal clawback will apply.

For quarter 3 the conditions of income protection remain as previously described, including that practices ensure that face-to-face urgent dental care is available for all attenders via direct contact or referral via 111, that efforts are directed towards patients at highest clinical risk and to addressing health inequalities.

The exceptions process will remain in place. Full guidance can be found here.

Regional commissioners will also maintain arrangements for Urgent Dental Centres (UDCs).

Prototype practices will be contacted separately about their arrangements.

Support for our NHS dental contract holders and the wider dental team

The welfare of our teams is important. That’s why NHS England has invested in the additional mental health support that is available to all NHS dental teams. This includes the ‘Looking After You Too’ service. NHS Practitioner Health is also available to dentists and further resources for the whole NHS dental team are on the NHS People website.

We are also delighted to confirm that, for this season only, we have secured funding so that frontline NHS dental teams are eligible for a free flu vaccination, paid for by the NHS. Further details of this have been communicated to you.

In addition to the recently announced pay increase for dentistry by the Government, NHS England is also making a change to the adjustment payment to help contractors. From Q3 we are reducing the adjustment made to payment for activity not delivered from 16.75% to 12.75% for general dental contract holders.

Continuing clinical prioritisation of patients

While access and activity has been impacted by the pandemic, it is important that practices continue to follow the advice of the Chief Dental Officer to prioritise patients according to clinical need.

Thanks to the hard work of NHS dental teams, urgent care has been back at pre-pandemic levels since December. Practices are reminded that they should not prioritise patients of lower clinical need over those in higher clinical need, such as urgent care or a member of a priority group such as children. As there is no patient registration within dentistry patients must be prioritised against clinical need and priority groups regardless of whether the member of public is on a practice’s business list or not – this is a condition of ongoing financial support.

Key details on clinical prioritisation can be found in the Standard Operating Procedure and the Chief Dental Officer has recently published a toolkit to support the recall of children for dental appointments.

Proceed with dental system reform

In our letter of 29 March 2021, we confirmed that DHSC had asked NHS England to lead the next stage of dental system reform and we outlined the six aims which would need to be met for reform to be viable. NHS dentistry is an important medical service and we are committed to exploring changes in line with the six aims.

Since March we have held several meetings with an Advisory Group and a Technical Working Group, looking at the challenges dentistry currently faces, the potential for immediate change and designing contract reform over the longer term.

We will communicate with you as soon as possible the progress in this area.

We trust with this support and fair contractual arrangements we can continue to recover NHS dentistry and deliver for our patients.

Thank you for your dedication to the NHS and its patients.

Yours faithfully,

Ali Sparke | Director of Primary Care, Dentistry, Pharmacy, Optometry & Standard Contract | NHS England and NHS Improvement

Sara Hurley | Chief Dental Officer England