The New (New) Contract

J'aime les Dents
This week, our man from Anfield ponders the reformed NHS Dental Contract

I love the NHS. The NHS is a boss idea. If you're not well, you go to see someone who knows how to fix you. They do their thing and away you go, all better. And you don't part with a penny. That's great news. Now, NHS dentistry is a wee bit different, in that you have to pay a little bit towards your treatment, but still, your fillings and crowns and whatnot are all very reasonably priced.

The current NHS dental contract is not without its critics. The current UDA (Unit of Dental Activity) system doesn't necessarily result in the best possible care for patients, as dentists aren't paid suitably for the treatment that they carry out, which can lead to corners being cut as dentists struggle to make ends meet, just like anyone else. The Department of Health have acknowledged this fact and are looking to tweak the current system to ensure that prevention is king, that there is suitable recompense for dentists doing the right thing by their patients and by measuring the quality of work provided, so that the patient (and the taxpayer) get their money's worth.

Of course, there was a need for a period of due diligence prior to the implementation of a new contract, so a pilot of the new contract was conducted in seventy practices across England to see how well the new system will work out in the big, bad world. There were 3 different types of pilot and for details of these, I refer you to the full report on the pilots, as the details are beyond the scope of this lovely article.

Changes

Being the riveting and captivating dental writer that I am, I shall use all the erudition and elegance that I can call upon to distill the 87-page review on the pilot into a few key points:

• The care pathway starts with an Oral Health Assessment which (surprise, surprise) assesses the patient's oral health and any systemic or external factors which may impact on the patient's disease risk in the future
• The patient's risk status will be categorised as Red, Amber or Green, depending on whether they are high, medium or low risk; though I'm sure that bit's quite self-explanatory
• As well as having appointments for any treatment that they require, the patients will have appointments that are used for prevention, such as oral health education, or having a scale and polish and fluoride varnish application. These preventative appointments have been given the very official title of 'Interim Care Appointments'. Fancy eh?
• The patients will be advised when they should return for their next Oral Health Review, based on their risk status and NICE guidelines

Consequences

It's difficult to summarise an 87-page document with such brevity and wit, but having read the report, I would consider these to be the salient points:

• For the patients who were regular attenders and were motivated, there were clear findings of an improvement in their risk status, i.e. moving from Red to Amber, or Amber to Green
• Periodontal care is much more widespread; thanks to increased patient motivation and education, periodontal health generally improved
• Risks are being managed and reduced using the new care pathway
• Auxiliary members of the dental team are playing a greater role in patient care

This has been a very quick overview of the contract pilots, which I hope has proved useful. For further details please see the various publications of the Department of Health.


'People ask me why, as a trainee dentist, I always seem to be in a bad mood. I tell them that I always look down in the mouth'
Garry Wilson