Tuesday, May 01, 2007

NHS dentists in trouble

Crazy rules

Dentists may have to pay back millions of pounds to the NHS because they have failed to reach their targets in the first year of a new contract. Some dentists face repayments of tens of thousands of pounds, and in a few cases more than 100,000 pounds. The impact on dental practices will be even greater because their income next year will be reduced, and it is feared that the problems may lead to even more dentists leaving the NHS.

The problem is the latest to hit the troubled NHS dental contract, which rewards dentists for the “units of dental activity” (UDAs) that they complete. Many dentists – nobody yet knows how many – have failed to achieve the UDA targets that were set by primary care trusts, and for which they have already been paid. One dentist said that the contract had turned him into “a UDA factory”, working flat-out to achieve the targets. Others said that the only way to reach the targets was to take on quick jobs such as extracting teeth, rather than root-canal surgery to save the tooth, which earns the same UDA score.

A survey by the British Dental Association (BDA) found that 61 per cent of practices expected to miss their targets. There are about 20,000 NHS dentists, so as many as 12,000 could face financial penalties. In practice the number is likely to be smaller, because as long as a dentist achieves 96 per cent or more of the target, the money owing can be paid off in the next year.

The BDA fgures are backed by a smaller survey by Denplan, a company that provides dental payment plans. This found that 53 per cent of the 122 dentists that it approached expected to miss their targets by enough for their PCTs to insist on “clawing back” money, and that they would receive a smaller contract next year. Another 13 per cent said that they expected to be asked to return money, but to be given the same contract. At least one dentist who spoke to Denplan said that he had been served a “notice of intent” by his PCT to reclaim 100,000 pounds for underdelivered UDAs. The dentist was still in negotiations with the PCT over the amount.

Susie Sanderson, chairman of the BDA executive board, said that the final figures would not be collated until the end of June. “It throws a real threat on the viability of many practices,” she said. “Dentists own their practices and have to invest very heavily in them. They need a high standard of equipment, and good training for their staff. They’ve invested the money in the practice, and they are pretty resentful.” Stephen Gates, managing director of Denplan, said: “Many dentists are beginning to think very carefully about their future. They have looked at the contract and said, ‘We can’t run a business on this basis’.”

David McBride, a dentist in Norfolk, said that he knew dentists who had not managed well under the new system. “Perhaps I shouldn’t say this,” he said, “but I think if you haven’t done the work, you shouldn’t be paid for it.” He agreed, however, that the UDA system was defective. “If a patient comes in and needs more than two crowns, it costs me more to do the work than I get paid,” he said. “So there is a temptation not to do things that need doing. There is a huge potential for supervised neglect.”

The BDA has told the Government that alternative ways of monitoring dental contracts must be found. “UDAs are fundamentally unfit for purpose,” Lester Ellman, chairman of the BDA general dental practice committee, said in a letter to the chief dental officer for England, Barry Cockroft.

A spokeswoman for the Department of Health said: “Practices have up to two months after the end of the year to finish reporting courses of treatment, so PCTs and practices will not yet know the final position. But if a practice has not carried out the agreed level of patient care, the PCT will have to discuss why this has happened and, if appropriate, adjust the amount paid to the practice to reflect the level of service delivered."



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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