Dental contract reform

Department of Health and Social Care (and later jointly with NHS England from 2013) have been testing alternatives or amendments to the current activity-based contracts and agreements since 2010 with the programme looking at both clinical and remuneration models. The programme offers opportunities to further improve oral health, reduce health inequalities and address issues with dentists’ morale, workforce retention, and patient access.

The Office of the Chief Dental Officer provides clinical leadership for the programme. The clinical aspects of the programme offer a clinical pathway which prioritises prevention and self-care in line with our long-term plan principles.

The remuneration system for prototypes offers a blended capitation and activity model which is closer to, and builds on, the 2006 contract and regulations. This combines a continuing capitation payment for prevention and a modification of the current UDA system for some, or all, ‘restorative treatment’. The prototyping has been achieved through introducing a variation to the current GDS contract or PDS agreement, covering the contract metrics.

Further information can be found on the NHS Business Services Authority website.

Update on next phase of dental contract reform

NHS primary dental care is an important health service and it is key we take well informed decisions to improve services. As detailed in our letter to the dental profession of 29 March 2021, NHS England and NHS Improvement has been asked to take the lead on the next stage of dental system reform. We can only do this by working with our partners and key stakeholders and the first Advisory Group meeting took place on Thursday 13 May 2021.

The purpose of this group is to provide advice to the dental system reform review team on all areas under consideration, including:

  • The impact of the wider primary care context on primary dental care which forms the backdrop to the review (for example new ways of working resulting from COVID-19, the development of Integrated Care Systems, Primary Care Networks and new commissioning arrangements, changing workforce and skill mix);
  • Lessons learned from the previous, current, pilot and prototype contracts;
  • The strengths and weaknesses of different contracting models, acknowledging that that no system is without flaws;
  • The role of contractual reforms in promoting high quality care, addressing unwarranted variations in care and health outcomes, improving health and reducing health inequalities;
  • Contractual options for the future, the likely impact of these and whether they meet the six key aims detailed in our letter which include that they are designed with and enjoy the support of the profession.

It is not within the Advisory Group’s remit to determine the contractual implications or decide any final changes. These will be progressed in a separate negotiating process with the British Dental Association.

This group will be supported by a technical working group comprised of academics, dentists and commissioners which has also had their first meeting.

Membership of the Advisory Group is comprised of the following representatives:

  • Ed Waller, Director of Primary Care, Chair
  • Gabi Darby, Director of Primary Care Commissioning Transformation
  • Shawn Charlwood, Chair, GDPC British Dental Association (BDA)
  • Martin Woodrow, Chief executive, BDA
  • Sara Hurley, Chief Dental Officer
  • Rebecca Harris, Deputy Chief Dental Officer and Professor of Dental Public Health, Technical Working Group Co-Chair
  • Ian Mills, Dean of the Faculty of General Dental Practice
  • John Milne, Care Quality Commission (CQC)
  • Neil Carmichael, Association of Dental Groups (ADG)
  • Alette Addison, Deputy Director Pharmacy, Dentistry and Eye Care, Department of Health and Social Care (DHSC)
  • Anne Ireland, National Lead for Dental Public Health, Public Health England (PHE)
  • Rachel Pearce, Director Commissioning for the South West
  • Nick Barker, Local Dental Network (LDN) Chair for the East of England
  • Sally Simpson, British Society of Dental Hygiene & Therapy (BSDHT)
  • Shazia Ahmad, Dental Associate, British Dental Action Group (BDAG)
  • Jacob Lant, Health watch
  • Jane Luker, Health Education England (HEE)

Secretariat and programme team

  • Rachel Foskett-Tharby, Deputy Director Dental and Ophthalmic Contract (Technical Working Group Co-Chair)
  • Carol Reece, Head of Dental and Ophthalmic Contracts

During this process we also intend to engage with different groups and organisations to ensure that dental system reform is informed by a wide range of views and perspectives including patients and the public, dental staff and their teams, commissioners and others.

We appreciate the wide interest in this review and will provide more updates as the review progresses.

Joint statement with the British Dental Association on dental system reform

On Monday 29 March 2021, NHS England made the following joint statement with the British Dental Association about the work we are initiating on dental system reform:

“Today’s letter on NHS dental contract arrangements, issued jointly by Minister Jo Churchill, NHS England and the Chief Dental Officer, represents an important new chapter in progressing contract reform in England.

The commitment to pursue rapid meaningful change across the next year will be particularly valued by those working in NHS dentistry. All parties have recognised the profession is seeking faster progress on contract reform. NHS England and the British Dental Association (BDA) are optimistic that the commitments given represent a new start for system reform, with the Department of Health and Social Care having asked NHS England to lead in moving the process forward over the next 12 months and beyond.

NHS England and the BDA look forward to working together immediately and at pace to take forward system reform, exploring how we can make the joint principles set out in today’s letter work for the profession and patients. Whilst we know that contract reform is not straightforward, we hope and expect that the six aims will offer a transparent framework to enable us to develop a reformed NHS system that provides high quality patient care and an environment where professionals can work to their full potential.

We will now begin the process of developing reform and will report back progress as soon as we can.”

Issued jointly by Gabi Darby (NHS England) and Shawn Charlwood (British Dental Association).