The prototype programme
We began testing changes to the current activity-based dental contracts and agreements, looking at both clinical and remuneration models through the prototype programme. The work was begun in 2010 by the Department of Health and Social Care, then jointly with NHS England from 2013.
The Office of the Chief Dental Officer provided clinical leadership for the programme. The clinical aspects of the programme offered a pathway that prioritised prevention and self care in line with our long term plan principles.
The remuneration system for prototypes offered a blended capitation and activity model which is closer to, and builds on, the 2006 contract and regulations. This combined a continuing capitation payment for prevention and a modification of the current units of dental activity
Further information can be found on the NHS Business Services Authority website.
First stage of dental reform – 2021-2022
Starting in 2021 an advisory group and a working group were set up to understand the challenges of the current contract, agree the aims of reform, and review the results of the prototype programme.
The advisory group had representatives from the British Dental Association, College of General Dentistry, British Society of Dental Hygiene & Therapy, Healthwatch, British Dental Action Group, Association of Dental Groups, OHID, CQC, HEE, and included a commissioner and a LDN Chair.
The working group included frontline dentists and academics, who provided technical expertise and knowledge. A series of 10 focus groups involving frontline clinicians, commissioners and patients/the public have also taken place.
Outputs from the 2021 engagement were taken into a more focused series of discussions with the BDA, and in our letter of 19 July 2022 we announced the first set of changes resulting from this engagement and development process. This represents the first significant change to the contract since its introduction in 2006.
The changes address many of the challenges voiced by frontline dental teams during the engagement period and will make a real difference to patients. This shift in the emphasis of financial reward and the re-orientation of clinical activity to those patients who need it most focusses on improving access to NHS dental care and our support for our valued dental teams by:
- Introducing enhanced units of dental activity (UDAs) to support higher needs patients, recognising the range of different treatment options currently remunerated under Band 2.
- Producing supportive material for patients, the public and dental teams around NICE recall intervals and introducing an extra field on the FP17 form to help peer review and monitoring of adherence to personalised recall intervals.
- Establishing a new minimum indicative UDA value
- Addressing misunderstandings around use of skill mix in NHS dental care, whilst removing some of the administrative barriers preventing dental care professionals from operating within their full scope of practice.
- Taking steps to maximise access from existing NHS resources, including through funding practices to deliver more activity in year, where affordable.
- Improving information for patients by requiring more regular updating of the Directory of Services.
A next phase of engagement to consider further reform will include front-line dental teams, patients, the public and sector representatives, with work ongoing in 2022.