Andy Hobson
So hello everyone and welcome to the Transforming Primary Care podcast. In this episode, we’re going to discuss how the dental contract is being reformed from April 2026 with the aim of making NHS dentistry more sustainable and rewarding for practices and hopefully increasing access for patients as well.
I’m Andy Hobson. I’m going to be chairing today and I’m the deputy director for dental commissioning across Yorkshire and Humber, and I’m joined today by a great panel of dentists who are going to talk these changes through with me.
These dental contract changes are an important and positive step and mean improved payment and claiming options to support patients with urgent care and those with higher needs, and there are measures to financially support and embed quality improvement and proposal proposals to enable all members of the dental team to be able to better contribute to NHS treatment. So there’s quite a lot in this package of reforms, quite a lot to get into including changes to how urgent care payments are being made, they’re rising by an average of 76% with upfront funding in place for practices to help manage capacity, and there’s also changes in there around practices being able to claim higher fees for new complex care pathways that should ensure better support for patients with high oral health care needs.
Today I’m going to be asking how these reforms can make a positive change for NHS dentistry and how they can help enable the delivery of the 10-year health plan and the three big shifts. And as I say, I’ve got a great panel of dentists joining me today to discuss it, so we’ve got Tom Robson, who’s a dentist at the Darlington Urgent Dental Care Access Centre and the clinical lead within NHS North East and North Cumbria ICB, Simon Hearnshaw is a training programme director for NHS Workforce Training and Education in Yorkshire and the Humber, and also clinical advisor for NHS Sussex ICB, Jane Moore, the Managed Clinical Network chair for Urgent Care in Yorkshire and Humber and the West Yorkshire Local Dental Network chair. Shiney Singh from Parade Dental Practice Leeds, also in West Yorkshire, and Steve Thompson an NHS Dental Associate and Local Dental Committee chair for Rotherham. Welcome everybody.
Andy Hobson
So the government’s confirmed in December that it’s progressing with this package of changes, I guess an interim step towards longer term reform. And I think we’re just a few weeks away now -in February we can expect some details of the clinical guidance and that sort of thing to be shared with colleagues. So we’re in that moment, we’re just waiting for the absolute detail of this package, but we still have got quite a lot to go at and quite a lot that we can understand about what’s coming down the line. So the government’s saying that these changes should offer more funding, more flexibility and better recognition for the care that practices deliver, but I suppose what I’m interested in is what it might actually mean for you in practices, Simon you’ve got your hand up?
Simon Hearnshaw
Thank you. I think it’s worthwhile saying at this stage that the consultation was an open process around 2300 responses were received from individuals and organizations. This was in lots of respects the listening exercise as well as a consultation, so broad support for the changes we know from the government response, albeit without the granular detail that we’re going to get next. I think it’s also really critical to note that the government has stated extremely clearly, you know that’s embedded in the NHS long term plan, isn’t it, that long term contract reform is under way. So the contract changes that we’re about to discuss, I think we’d all consider as a move in the right direction, but they do not represent the final destination, Andy.
Andy Hobson
Thanks, Simon. So, I wonder whether we start with one of the big hitters in the package of changes on urgent care. What do people feel that a move towards a £75 tariff for urgent care, as I say, that’s a rise by an average of 76% for urgent care., will actually mean in practice for you in practices? Tom, do you want to come in?
Tom Robson
Yeah. So when you look at the research literature and the evidence that’s generally surrounds urgent care, there are many drivers that change behaviours.
They’re from education and experience to opportunity, but the key factors for me are reward and quality and outcome. So if you increase the reward you would consider perhaps as the layperson that will almost certainly increase the efficiency of a particular service or the propensity of a particular service to deliver a particular type of service delivery. However, we found in the northeast of England when we offered a similar arrangement, it didn’t on its own change behaviours. I do think there needs to be a quality and outcomes framework associated with this to ensure that it just doesn’t explode antibiotic prescribing, which I think is also in the 10-year plan. So it’s important that we get defined clinical outcomes and patients are given definitive care as opposed to care deflections, which is a risk now having an appropriate fee to allow clinicians a reasonable amount of clinical time.
Increases the likelihood that you’re going to get defined financial outcomes, and so in that respect, the increase in fee is a welcome one because increase in fee equals increase in time and so one would expect at this point to get some improvements in terms of access and and improve clinical outcomes.
Andy Hobson
Thanks Tom. Jane?
Jane Moore
I think this is where the urgent care MCN can help a lot because we can put peer review networks in place, which can help to ensure standards are delivered and that we have high quality, urgent care, not just volume of urgent care.
Andy Hobson
Thanks, Jane. So yeah, that managed clinical network for urgent care is one of the ways that we can help connect different providers who are delivering this urgent care. And I guess spread that best practice in terms of clinical standards. Shiney do you want to come in?
Shiney Singh
Yeah, I think I’d like to just go on that point there, Jane. So myself at the practice, we actually sit as one of the GDP practices with an urgent care contract on a long-term basis. So it’s actually within the contract, so we feedback from the clinic itself. So you’ve got urgent access centres which do come on to the MCNs. You’ve got various aspects to it, but then, yeah, the idea of having regular meetings, looking at the quality outcomes, we actually do look at antibiotic prescribing. We make sure there are set standards around that. We also question each other. It’s quite it’s a very informal but formal way of providers bringing a problem to the table, things that they might have faced also justification on prescribing, looking at the outcomes also repeat appointments. We’re looking at stabilisation, so I think for us we have we’ve incorporated the urgent care but not to be seen as urgent care and you’ve gone and there’s nowhere else to fall back on. The idea is to prevent repeat urgent care appointments. So we quite often will do what we call a course of stabilisation. Some patients decide that’s for them some patients don’t – you will always get patients who are looking for just that urgent access and immediate pain relief and they may or may not come back to continuing care. But where we can we provide a course of stabilisation and prevention, to try and prevent that repeat process. And we’ve been doing it for a few years now and I think with the regular meetings we have and when we touch base with the managed clinical networks, it allows us to know whether what we are doing is correct, and if there’s anything else that we can improve on, I think without that regular meetings you can sometimes fall into the trap of are we doing things correct? Should we be doing that? What are other practices doing? So you just want to make sure the standards as we go along, which I think can be a challenge. I think urgent care presents itself as one of the most complex things we’ve taken on as a dental practice, so you’ve got to imagine we’re talking with patients who have built up rapports over some, in some cases, it’s been decades we’ve known our patients, but with urgent access you’ve got to really make a rapport with a patient. You’ve got to understand where they’re coming from, the challenges they’ve faced, to not be able to access. You’ll find that some of them have very complex background and dental histories, and you’ve got a very short period of time.
So what I’ve obviously fed back a lot is for myself and associates that carry out any urgent access clinics. It’s we’re not under a pressure. I think there’s a good move away from targets and UDAs, which in the urgent access, they’re not there – we’re looking at protected clinical time, we have protected slots that we can recall patients back into to stabilise and for an associate or anybody carrying out this sort of clinic it’s all been arranged to give us the freedom, the autonomy to get on, the professionalism to do what’s right for the patient away from what I’d say, the UDA treadmill that in the past has always been a struggle of how can we do so much in so little time and we’re chasing targets, whereas this is a totally different shift in care for a patient which has really worked.
Andy Hobson
That’s really interesting and I suppose one of the features of the changes is moving away from just paying on units of dental activity when a patient has been seen and instead paying a portion of the payment upfront and is actually paid, you know whether a patient attends or not, and hopefully that is going to help, I suppose. The intention is to create that protected clinical time that you’re talking about there showing in all practices, Steve, what’s your perspective on how this might work for you in Rotherham?
Steve Thompson
I’ll reiterate what we’ve heard about the sessional rate urgent care access across Yorkshire – there’s not more funding, it’s the same funding just rehashed. And you know, you’re shifting more of that funding over to access. So everything’s converted back to UDAs at the end of it. So we’re taking away from the continuing care, whereas the sessional schemes allowed for urgent and stabilisation. This doesn’t seem to allow for any kind of stabilisation or continuing care, it is purely focused on the urgent, the unscheduled, getting them out of pain, fixing that broken tooth and then telling them we have no capacity or now we have reduced capacity to take you on as a new patient despite the enhanced pathways etc. We’ve also had concerns from practitioners that it might be a free-for-all – that communications may go out that everybody can ring any dental practice and get in and they must be seen within 24 hours if it’s urgent and they must be seen within seven days if it’s unscheduled. And I think we’ve had a lot of feedback from worried practitioners on the level at which that would be mandated. And if you fail to meet that target, how will claw back work? You know, those are the sorts of issues coming our way. It’s from individuals who are stretched at the moment, thinking that they will be inundated with everybody from April.
Andy Hobson
Yeah. So that’s right, because the reforms are bringing in this, this minimum level of urgent and unscheduled activity that all practices will be expected to achieve. And I suppose what that’s trying to address is that at the moment we’re seeing some practices really engaged in delivering urgent care and treating lots of patients and there are others who don’t do a lot of that activity at all, so trying to sort of raise the floor, I suppose so that there are more appointments available and everybody is contributing towards that urgent care piece. But I understand what you’re saying there, Steve, that could be challenging for practices who aren’t doing a lot of that activity at the moment and who are going to have a level that they’re expected to meet now. We’ll need to kind of work through how we communicate with those practices and make a plan for delivery and make sure that we’ve got, you know, routes for patients to follow, to get to those practices and receive care without, as you say, sort of inundating practices with communications from patients and I think patient communications in this is a really important point generally. It can be quite a confusing landscape to navigate whether you should be contacting your local dental practice or a dental practice that you don’t have a relationship with or phoning 111. And I think we do need to help patients go down the right route to receive the care they need.
Steve Thompson
I also think it’s misleading looking purely at current urgent care, because quite often as dentists, we often see a patient for an urgent – if they need a filling, I just book them back for their filling, You know, put a temporary in and don’t send an urgent, get them back, do the filling. And I think there’s a lot of practitioners do that because it’s – they’re doing the patient a favour. You know, I wouldn’t be charging a separate urgent treatment for an open and dress, a GIC patch-up. I don’t even put a form through. You know, they’re the sorts of nuances on the ground. When you look at the numbers, I’ve looked at my urgent care percentage today. I see 10 emergencies every day, and I’m probably only delivering about 1% urgent treatments throughout the year. It’s just how I choose to put things through in a different way and there’s a lot of that.
Andy Hobson
Thanks, that’s really interesting. Simon, I know you’ve got experience down in Sussex being a clinical advisor there. I mean, we’ve talked a little bit about the sessional scheme that we commissioned locally in North East and Yorkshire. Are there examples from other areas that we can learn from, something that we can be drawing in from your experiences in Sussex?
Simon Hearnshaw
Yeah, there’s a lot of stuff going on around the country, Andy, just coming back to the priority and the emphasis on urgent care, I think that’s the right position for ICBs and government to take because it’s right at the top of the hierarchy of oral health need for a patient and for too long, we’ve seen far too many patients unable to access urgent dental care and either remaining in pain Andy, or going down the shed to indulge in some Dickensian DIY treatment – that’s unacceptable in 2026, so it’s absolutely right to fix urgent dental care. I think we’d all agree with that and it’s the platform for improving population oral health. The emphasis that’s been put on urgent care has had a kind of a really big impact in total patient care. We know that ICB schemes have delivered hundreds of thousands of additional urgent dental care appointments. You know, there’s some great work going on around the country, particularly around Yorkshire and Humber, North East. Up in the Manchester area as well and down in Sussex. So our programme we developed was a sessional programme. We work with a local dental helpline. We’ve worked with local social care departments, GPs, even A&E services, to care-navigate patients into that programme. We’ve developed systems for booking patients in directly – we’ve developed workarounds that enable us to do that. We’ve got an information site up on an intranet. So we’ve started to communicate with all our providers, all our performers, not just on urgent dental care, Andy, but on a whole range of stuff that help practices feel part of the NHS and part of the ICB agenda. I think the biggest take home for us and Tom will be able to give you similar stories, is that we’ve managed to increase the numbers of patients that previously rang our help desk where we were able to get urgent dental care appointments for around 143 patients a month to closer to 900 patients a month now. That is the power of the 700K programme for patients What’s really interesting is that’s starting to happen – probably at different rates of progress, I know Tom has a really sophisticated programme up in the North East that we’re learning from, but we’re starting to share information across ICBs as well, which is great – sharing best practice.
So we shared our intranet idea with Tom and yourself and we’ve nicked Tom’s great ideas around booking patients in directly. So that’s an important step in terms of collaboration across ICBs. In terms of the contract change, you’re quite right, it’s about contracting a set level or a minimum threshold of urgent care appointments. It’s only a modest increase, Andy. I think it’s going to be much smaller than practices are worried about and some of our practices may find that their contracted level may actually be below the level that they’re delivering right now. You’re quite right, some practices will have to step up, but that’s levelling up and I don’t think we need to make any apology for that. It’s a win win win as far as I’m concerned, relatively speaking – we’ll have to see how this pans out for everyone. But for ICBs you can deliver the urgent dental care need to meet population health, urgent dental care requirements. For practices you’re getting paid more to deliver better quality care and for patients, and these are the most important people I think in the systems we provide care for, they’re going to have more appointments available to them and they’re going to get better quality of urgent dental care as well. So I see it as a win, win, win. But we’ll have to see how it plays out.
Andy Hobson
It’s great to hear that. I love that stealing with pride between ICBs. You’ve mentioned there a bit of the work that Tom’s involved in in North East and North Cumbria. I wonder, Tom, if you could just briefly describe the setup that you’ve got for urgent dental care there and how that’s helping patients really.
Tom Robson
Sure. So for us, there were two main drivers. The first was being equitable and ensuring that those that had the greatest clinical need were able to access care in a timely manner. And that’s for patients who have a true clinically assessed dental clinical need that’s within 24 hours and also providing some equitability for those with an unscheduled care need. So we’ve established this network of urgent dental access centres with 30 surgeries’ worth of capacity over 23 sites delivering just under 110,000 appointments a year and a proportion of that is given over to NHS 111, who directly book into all of the sites using the interoperability toolkit because as you know, dental software is not compatible with NHS 111 software. But we have a workaround within our 111 provider. And so if you’re a patient, you would phone our local 111 provider, you’d go through NHS Pathways, which is the algorithmic assessment of your clinical need. And then we have a dental clinical assessment service which is a nurse-led modifying service. So if there is something on the cusp of patient ‘ do they need to be seen today, do they not?’ they could be put through to a clinician who will be able to either channel-shift up the level of acuity or channel-shift down depending on what their clinical assessment was. But broadly the majority of cases are assessed by a health advisor within 111 and then just directly booked into the network. And that’s working very, very well with direct booking and of course part of that is to protect the slots so we ensure the patients can get in – the practices can’t book into these slots, they’re protected within the network. And then the other percentage is available for community booking and we have an ICB central website that you can click into and then you can click on your area within the North East and Cumbria region and that will bring up the practice urgent dental access centres that are geographically closest to you. And then you click on that one, it will take you direct through to an online booking portal and you yourself, the patient can then make that appointment. Those appointments are a rolling five day forward window. So there’s a day’s worth of appointments released every working day. And does it solve the problem? Well, it goes to some degree to mitigate the problem. I think there’s a significant way to solving the problem if I can use the word solve in terms of 24-hour access through 111, because we’ve noticed now the patient groups as they know they can reliably book in online are tending to phone 111 less. And so as a commissioning team, we’re chasing down the numbers that are allocated to the capacity that’s in 111 and then increasing up the capacity within the online booking system, but essentially patients who can who need to get in because of the defined clinical need can get in and there is some measure of equitable access for the community. That’s clearly not enough, but it’s equitable and it’s not managed by the practices and so it has worked very well and there’s positive feedback from all stakeholders, including Healthwatch, who’ve reviewed this independently. So I think we’re rightly proud of the initiatives that we’ve taken in urgent care in the north east.
Andy Hobson
That’s fantastic. And what was that, I suppose in practice for a patient that direct booking sounds really powerful, the ability to just go on the website and find a slot. Is there an example, I suppose of a patient that you can think of that’s really benefited from that equitable access to care and direct access to care recently.
Tom Robson
Last patient I just saw was a patient who is a just newly diagnosed cancer patient who’s about to go on alendronic acid and needs 3 teeth removing. Should be able to get prompt or timely care that doesn’t disrupt his overall general care is significant I think.
Andy Hobson
Yeah, that’s amazing. And if they’re you know, otherwise there’s difficulties in accessing NHS dentistry, which we know there is at the moment, having that route for those sorts of patients is just so important. Thanks, Tom. Jane, I’ll bring you in on urgent care and then I’ll move us on to our next topics.
Jane Moore
Yes, thank you. I think that’s a fantastic system that you’ve got going in in the north east, Tom. We’ve invested a lot of extra money in quite a lot of programmes in Yorkshire and Humber, so we’ve got urgent care sessions, we’ve got booking via 111 and we understand that the extra money that we’ve invested and the programmes that we’ve got going will be able to continue for urgent care going forward even with the contract reforms from the 1st of April. But we have also invested a lot of money in that access for patients such as the one you’ve just spoken about Tom and for the patients with cancer- patients about to start alendronic acid. We’re in the process of facilitating GP to GDP referral for those patients and we’ve also got programmes for the homeless, children and young people and domiciliary care and refugees, and we’ve invested money in all these programmes which we will be continuing to run in the next financial year alongside the contract reforms.
As MC and chair – obviously very involved with the upcoming procurement for urgent care that we will have in Yorkshire and Humber and we will be looking at how the changes and contact reform can feed into and inform our urgent care procurement and we are likely to focus the procurement on treatment centres providing out-of-hours care for bank holidays, weekends and through the night where the practices will be providing urgent care more during the daytime. So we’re looking at all these aspects going forward.
Andy Hobson
Thanks, Jane. So we’ve talked quite a lot about the changes coming for urgent dental care. There’s a lot of other changes covered by this package of reforms. Of those, I suppose the other big hitter, as I think about it I think, is the introduction of complex care pathways and so this is increased payment and a different way of paying on a longer-term basis for patients with the most profound oral health care needs. So we’re talking about multiple teeth with significant decay or gum disease, which is you know, present and causing trouble for patients. What do those complex care pathways and their introduction mean in practice for practices and for patients. If someone wants to come in and talk about that, that’d be great.
Shiney – you come in first and then we’ll have Simon.
Shiney Singh
I’ll give this a go It’s a brief outline of what will be a really complex next update, you know we’ll see how it goes. But if the direction of travel is to assist dental practices – NHS practices which are continuously struggling to reach targets, (it was almost as if you’re damned if you do, you’re damned if you don’t. You want to take on your patients. New patients will require time and on the other hand, the more time we spend with complex care, the more we are given ‘You’ve not hitting targets’, so you were just stuck in the middle as a dentist.) I see any move in the direction of travel, which is moving away from targets and moving towards patient care, you’re going to be on the right lines. Now. I don’t know if the details will be changed, amended from what they are at the moment. They’re only just being come out, but I absolutely love the idea of the ability to take on patients with complex care in a controlled environment where we are looking at how to look after them, we’ve got the time to look after them. The funding is appropriate and we are not being penalised for missing targets on the outside. So if that’s the direction of travel for new contract, that’s only going to be a positive, Will it ever be perfect? I think in a health service, no, we have to learn to work within certain frameworks and it is difficult. It’s all challenging. But any move that helps us as dentists take on patients, help people with their care and become part of the practice on a long term model. We’ve been carrying out a lot of the urgent care quite a bit. So just to correlate that into the new complex pathway, if we imagine urgent care is there for a reason and I think the reason why urgent care is required so much is because there’s an inability to get in as a registered patient. We’re just plugging a gap. So if it’s almost if complex care pathways might be the real answer to the urgent care issues, so as patients are able to be taken on by practices, we’re about able to then build up a relationship, do the prevention and it takes time. And you want them to be within part of your team to do that so.we won’t have a gap of urgent care to plug in if we can initially take on patients. So if they know the access is there, they know the stabilisation moving on to more definitive care, we can give them that plan from start to finish. Let’s see if it works. I’m sure over the next few months there’ll be positives and negatives, but if we keep the approach at this stage super positive, I think it’s just the right thing to do to support practices with complex care patients so we can take on new patients. The worry that I can’t access an NHS dental practice, let’s get rid of that worry from patients. There’d be nothing nicer to hear then under the next contract reform, even though this is a small part of a longer reform process, if we can move towards a direction of travel which shows patients they can access NHS dental care, they can fix problems that are not just urgent emergencies, but preventative problems and have some definitive complex care associated with it that that would be.an amazing turn around in the 20 years I’ve been doing NHS dentistry and it’s been nothing but an access struggle.
Andy Hobson
Thanks Shiney. I think that’s absolutely the intention here. We have had I think a lot of feedback nationally that patients with sort of the most complex care needs, the existing payment structures in the NHS dental contracts, just kind of I guess there’s a cap on how much we will pay for that first course of treatment and in some cases that you know it might work for people where there’s a few teeth with decay and it might pay reasonably. But as you get to teeth with, you know, patients with 5,6,7 teeth needing that kind of care, the NHS contract just hasn’t been remunerating practices fairly for the work they’ve been doing, so this is an attempt I think to make that a fairer payment system and reflecting the work that’s required from the team to take on those patients, and hopefully that means that we move away from the feedback that we have been getting where practices are feeling worried to take on new patients or even as you say Shiney to see patients on an urgent basis because once you get them in the door of the practice and make an assessment of the care that’s required, you might find well, actually you know, there’s so much care that’s required here,. the current NHS contract isn’t going to pay me reasonably and fairly for the work that I need to do with that patient. So that’s been I think a real barrier for practices taking on new patients. I don’t know if that’s an experience that that any of you have had or could relate to, and to what extent you think the proposals might address that? Simon
Simon Hearnshaw
Yeah, I agree absolutely with Shiney. I think what this does, this contract does change is it allows dental teams the choice to place patients on a complex needs pathway so they can choose to put them on this pathway where the aspiration is the time taken to deliver that more complex care is remunerated at levels between, you know, just under 250 quid and just over £700 depending on the complexity of care and whether that includes dental decay and periodontal disease. For patients, it’s good news, isn’t it? Because you know, I think we’re starting to see this continuum of care through from urgent care, unscheduled care into continuing care where a patient with a lot of unmanaged disease can then access care, hopefully in an ideal world, and be placed on one of these pathways where they’re made healthy. These pathways with the details still have to come out, but it includes quite a lot of prevention as well, and you know, with our flexible commissioning programme, which obviously has an all health champion component and a prevention component, a lot of our practices are well placed to deliver this extremely well in my opinion and I think the other point again is that this isn’t about UDAs, is it? It’s a flat fee. We’re starting to see that shift from UDA-centred care to a greater equality of payment? I think so. We’re moving away from UDA inequality, which frankly I think is unacceptable and it’s great to see.
Andy Hobson
Just for our listeners, Simon, do you mind just explaining what you mean by that UDA inequality and why that’s present in the current system?
Simon Hearnshaw
So at the moment practices get paid a certain amount for delivering a component of care and that can vary. Across Yorkshire and the Humber. I don’t know what the range is, but I would bet it’s somewhere in the region of maybe £29 up to £50. And that’s a crazy situation, isn’t it? So this starts to level that that playing field, which I think it’s a great thing.
Andy Hobson
Thanks, Simon. Shiney, you want to come back in?
Shiney Singh
Yeah. I just wanted to touch on a point that you mentioned about payments and sometimes I I think it’s a really awkward discussion and sometimes people just don’t really want to bring up certain things when it comes to the reality of providing care. And what I think as a practice, rather than the physical pace one gets, it’s the overall concept. I could give you 100 dentists and if you asked everybody if it was just all about the pace and it’s it really isn’t. So I just wanted to bring back the idea of having a contract where you are told to hit a target which is irrespective of a patient’s outcomes or health is the main driver why we are struggling in NHS dental care to recruit younger team members. So when we talk about the next contract reforms, it’s so important to look at where the direction of NHS dentistry is going. Listen to the younger dentists that are electively choosing to have an alternative career pathway and people always think it’s about the pay. It really isn’t. I can speak for handfuls of younger associates I’ve talked about. They will take less pay, but for more longer appointments for the quality and care they can deliver to patients. So it it ultimately boils down to the movement away from dentists feel like they’re under pressure to hit the target just an appropriate level of funding. So when we talk about whatever numbers the new contract reforms are, I don’t even know them off the top of my head to be honest, it’s not the biggest part. It’s the direction we’ll be towards. It’s not on the UDA treadmill and you will find into the clinical ability for each dentist, that time frame that you can do your work in, there’s no pressure and that’s more of a rewarding long-term atmosphere to be in as a dentist. I’ve spoke to a few younger dentists and anything that can move us away from the current target driven culture, it would be great and it’s nice to see complex care rewarded for the fact that I’ve talked to a few older and younger dentists and the career pathways for a young associate coming into dental practice, they want to be able to provide complex care and we need to give them a career ladder. You don’t want to be starting your dentistry in your early 20s and have 5000 UDAs and that’s you done for the next 20 years do you think, Monday to Friday, go home? You want to be able to advance as a clinician you want to be able to keep up with your skills and I think clinics like this, initiatives where complex care comes in.
It will be an exciting change as well as the remuneration parts of it, yes,, but actually clinicians will be interested to learn ‘well. I can go and improve my skills outside of my GDP but stay within the NHS. I will be rewarded for providing complex care under these pathways.’ It’s a great move. I think there’s way more to go. I’ve talked a lot with local commissioning. Whether people would be actively looking at funding dentists in practices to start to take on more complex cases, reduce the need to refer out- if we could keep things within an NHS dental practice, new contracts could have a patient journey from start to finish within one practice all associates will be given that drive to up their skills, have a look at dentistry as a career within the NHS rather than a short sort of stop gap. Rather than moving into the private sector. So yeah, I just wanted to touch on that really, rather than just all being about remuneration. It’s that long-term career as well that we desperately want to see for younger associates coming into the workforce.
Andy Hobson
Thanks, Shiney. I think that’s so important to link that you know, I think we sometimes separate these questions of workforce and retention recruitment – thinking about that separately to these sorts of payment models. But they absolutely link and it’s not just to say about the amount of money, but it’s how we’re paying and the messaging that we’re giving, I suppose, by how we pay. I think that’s really interesting reflections. Steve, do you want to wrap us up on the complex care pathways?
Steve Thompson
Yeah, it’s to go up against it’s moving away from the UDA system treadmill. It’s not really because it’s all converted back to UDA’s. And levelling the playing field. It’s just reversing it. So those that had really high UDAs in high needs areas get less UDAs when it’s converted back from the cash value – those in the leafy suburbs with low UDA rates traditionally get a higher return in terms of UDAs when it’s turned back. You know it’s great that we’ve got band 2B for multiple fillings but really Care Pathway 1 only equates to 8 UDAs. And it’s a choice for practices to choose between 5 UDAs that they get now or enter onto a pathway that again we have very little detail on the time scales of reports to be six months that you have to sort of stretch it out over – longer when it’s the one involving perio as well and practitioners almost would possibly not want to risk patients on a six month pathway failing to attend turning up for multiple urgents along the way, they might rather cash in their UDAs on a 2B early on. I still think the whole thing is seen as the treadmill system, not quite as they’re levelling the playing field and they’re moving away from the UDA system that seems to be touted.
Andy Hobson
Thanks. And I suppose what we mean by that is, is not paying on the basis of one course of treatment credits to so many UDAs. And you’re not necessarily, you know, at the moment we know that an associate you’ll be keenly aware of the number of UDAs you’ve delivered on a given day, and you know, associate dentists are paid on that basis, aren’t they in terms of, you know, as self-employed individuals working within a practice subcontracted a number of UDAs. I suppose I understand that at the end of the day, this will all be converted back into UDAs for the purposes of reconciling against the contract. What we’re aiming to do and what I guess I’m hearing from you, it’s not clear that, you know, we’ll succeed at this straight away. But I think what we’re aiming to do is bring it in changes that allow a clinician to spend the time that they need with a patient and not feel that they are being put ahead or behind of a given target. But just giving kind of an appropriate clinical care and that there’s a payment model that’s going to pay that dentist fairly for the care they’re delivering. But I guess I’m hearing from you some worries that this might not achieve that in one go. And I suppose we recognise this is a bit of a, as we’ve said, an interim step.
Steve Thompson
If you look at the review that that was carried out, only 52% of dentists agreed it would incentivise them to provide care for complex needs patients. When you look at the government’s review of the consultation.
Andy Hobson
So I suppose that’s a 50/50 split then from the profession, and I suppose that’s as good a place we can leave this as any – it’s a little bit of a wait and see. I think we’ll all be focused over the next few months as we see that clinical guidance coming out, as we see more detail about what these changes mean for practices we’ll be looking to bring those in in as successfully as we can, we hope and then we’ll be monitoring this closely. So just to sort of wrap up, this is all sitting within the NHS 10-year plan and our medium-term planning framework for the NHS. How do these interim changes to the dental contract sit within that and the three shifts that are talked about there in terms of prevention and moving from hospital to community and shifting to digital? Simon.
Simon Hearnshaw
Yeah, I think there’s a strong shift in prevention. So we know that one of the contract changes is to be brought in. It is a 0.5 EDA fee for dental nurse fluoride varnish application. Of course, we’re in a strong position in Yorkshire and the Humber because we’ve trained around 600 oral health champions with the skills to deliver this, which is great from a Yorkshire and Humber perspective. You know that to build on that there’s the revision of fidget sealant funding up to band two, we don’t quite know how many UDAs yet do we? That’s kind of come into detail, but there’s a shift to put that into Band 2, which is good. It’s evidence based along with fluoride varnish, and that builds on things like the national supervised toothbrushing programme that’s already been implemented. 600 thousand children moving in core 20 populations and that’s up and running now, expansion of fluoridation in Tom’s area and we hope it comes to Yorkshire and Humber soon. We’ve been campaigning with it for a long time and I also think the earlier dental care agenda and we’ve heard from everyone today about the links within primary care – they’re becoming established between primary dental care and primary medical care and primary pharmaceutical care. So we’re starting to see kind of neighbourhood services being embedded in practices as well which is a good thing, and I think that’s all part of the 10 year plan, isn’t it? And also I think it’s important to say contract reform is front and centre in the 10 year plan. These are small steps in the right direction, fundamental reform is necessary and it’s coming.
Andy Hobson
That’s great. Thanks, Simon. OK. So we’ll look to wrap up there. That’s been a really interesting conversation going through where we are on urgent dental care, talking about the introduction of these new complex care pathways. And then just a little bit there about why -the strategic context in terms of prevention and longer term reform coming down the line. Can I give a huge thanks to all five of our panel members, it’s been really great to hear from you all and hear your range of experiences. And thanks everyone for listening.