Next steps on supporting the recovery of NHS dentistry

01 October 2021
5 min read

An update from Sara Hurley and Ali Sparke

In the update, Sara and Ali write, “We have written to general dental service contractors to announce the next steps to support the recovery of NHS dentistry, with contractual arrangements from October to December.

“This includes a safe increase in the activity thresholds, a continuation of clinical prioritisation, support for our NHS dental teams and an update on dental system reform.”

Contractual requirements
Expanding on this further in the update, it is revealed, “In August 2021, mean performance was 70 per cent and 63 per cent of contractors are anticipated to achieve or exceed 60 per cent of their contracted Units of Dental Activity (UDAs). Many contractors are safely exceeding the threshold.

“But we recognise it isn't easy and that right now it's too difficult for patients to get an appointment. On behalf of patients, our shared mission now is to increase access and recover activity.

“In our letter to dental contractors, we have given details of our next steps to support this:

  1. Contractual arrangements that safely maximise access and activity
  2. Support for our NHS dental contract holders and the wider dental team
  3. Continuation of clinical prioritisation of patients such as those with urgent need and children
  4. Proceeding with dental system reform.”

What are the key contractual requirements?

  • There will be ongoing contractual protection for practices unable to deliver their full contractual activity between October and December 2021. During this period claw-back will not be applied to practices delivering at least 65 per cent of contracted UDAs and 85 per cent of contracted Units of Orthodontic Activity (UOAs).
  • The rate of claw-back will then reduce linearly down to a lower threshold of 52 per cent of UDAs and 60 per cent of UOAs. Below these levels normal claw-back will apply.
  • In addition to the recently announced pay increase for dentistry by the government, NHS England is reducing the adjustment made to payment for activity not delivered from 16.75 per cent to 12.75 per cent for general dental contract holders.
  • Regional commissioners will also maintain arrangements for Urgent Dental Centres (UDCs).
  • We have concluded we are only able to set contractual priorities for the next quarter as we need to retain the ability to respond to the revised IPC requirements later this year.

The BDA's response
However, the BDA has criticised NHS England's approach to the latest hike in NHS activity targets, "imposed with minutes to spare, and ahead of any meaningful relaxation of covid restrictions."

From Friday October 1, practices will be obliged to meet 65 per cent of their pre-covid activity levels, or face financial penalties. Around a third of practices were incapable of achieving these levels in recent months. The ‘cliff edge’ – the level below which practices face returning a substantial proportion of their NHS funding – will also rise to 52 per cent, leaving hundreds of already struggling practices at risk. One in six practices were delivering below this level in August.  The target will remain in place until 1 January 2022.

Practices are still facing major limits on capacity owing to standard operating procedures designed during the first wave of the pandemic.  In response to BDA calls to commission a roadmap to ease covid restrictions, all four UK chief dental officers issued a rare joint statement in June, committing to a review. Approaches to ease restrictions are set to be consulted on, but there is no clarity when any changes will take effect, or indeed what levels of additional capacity this may unlock. Increases in thresholds at this point therefore remain premature.

The BDA has pressed for restraint on targets, underlining that any significant increase will further undermine the long-term sustainability of services in England. It has said clear ambition is also required from government to honour pledges to reform the widely discredited NHS contract. In recent BDA surveys nearly half (47 per cent) of dentists indicated they were likely to change career or seek early retirement in the next 12 months should current covid restrictions remain in place. The same proportion stated they were likely to reduce their NHS commitment.

Shawn Charlwood, chair of the British Dental Association’s general dental practice committee, said, “The timing of this new target is simply unacceptable.

“Dentists are at their wits end, and many are already reconsidering their futures.  We need a roadmap to meaningfully ease covid restrictions, not further hikes when plans are still on the drawing board. 

“This service was in crisis long before covid struck. We have pressed for restraint on targets, but we need to see real ambition on reform if this service is going to have a future.”  

Wesleyan Group's response
Meanwhile, Michael Copeland at Wesleyan Group, the specialist financial services mutual for dentists, said, “For many, this new announcement brings extra worry and stress as dentists look to understand how they will be affected.

“Whilst the NHS expects 63 per cent of contractors to achieve or exceed the new 65 per cent threshold, that still leaves a sizeable proportion of practices that could find themselves falling short.

“Yet again, dentists are finding out that they are being asked to do more just to avoid falling behind – and with almost no time to prepare. To make matters worse, this announcement comes just as furlough ends, increasing the risk that jobs are affected at a time when practices are working incredibly hard to get back to some form of normality.

“Whilst some might view this as only a small increase in target, continuing to raise the bar in this way while headwinds still abound will only heap further pressure on a workforce already showing real signs of strain, and could ultimately lead to many more dentists choosing to change career or retire early, and shuttering their practices along the way.”

Flu vaccinations and booster jabs
Sara and Ali then moved on to discuss free flu vaccination for frontline NHS dental teams, sharing, “We are happy to announce that for this flu season frontline NHS dental teams are entitled to a free flu vaccination - paid for by the NHS.” This includes “non-clinical staff directly involved with the provision of NHS services on a day-to-day basis who have face-to-face contact with patients, for example reception and counter staff who play an integral part in patient care in primary care settings,” however, “Any non-clinical staff not directly involved with the provision of NHS services on a day-to-day basis or do not have face-to-face contact with patients (for example cleaners, back office administrative staff, counter staff) are not eligible for vaccination under this scheme.”

“We can also confirm that dental teams, including in private practice, are entitled to a Covid-19 booster jab, too,” they add. More clarification on this is also provided, “To be eligible, you should have direct contact with people at higher risk from coronavirus (COVID-19). For example you work in a clinical role (such as a dentist, dental nurse, dental hygienist or therapist) or you have contact with patients in a non-clinical role (such as a receptionist).  Please note that administrative staff who do not have any direct contact with patients are not eligible.”

Water fluoridation
They end the update sharing, “Finally, the UK's four Chief Medical Officers have stated their view in a joint statement that community water fluoridation is safe and beneficial for our oral health.”

Sara expands on this, commenting, “The Chief Medical Officers are right to point out that fluoridation is not a replacement for good oral hygiene. Nor will it spell "the end of dentistry” - the need for dental care across a whole range of oral and dental conditions will continue.
“As the robust international evidence shows, water fluoridation is another public health tool that can reduce the incidence of tooth decay amongst adults and children – saving potentially thousands of teeth and improving oral health inequality in the process.
“As the Chief Dental Officer, I strongly believe that water fluoridation can benefit the nation's oral health.”