Source · Select Committees · Public Accounts Committee
Recommendation 8
8
Deferred
Concerns raised over NHS dental contract's UDA rates, incentives, and uncompetitive funding.
Conclusion
In the written evidence submitted to our inquiry, concerns included that: • UDA rates are linked to the figures used in 2006 which no longer reflect current need.13 Rates vary from practice to practice so dentists in the same location may be paid different amounts for the same work; 14 • the contract is rooted in ineffective incentives that make it easier to complete targets by seeing patients with lower levels of need, while making high–needs patients the least “welcome”; 15 and • the overall level of funding means that NHS rates are not competitive with the private sector. The resulting contraction in NHS coverage leads to a “feedback loop”, in which the design of the contract leads to underspends and less spent on dentistry than was intended.16
Government Response Summary
The government agrees with the concerns and states that work is underway on its ambition to reform the dental contract, focusing on prevention and retention. However, it indicates that a realistic timetable will be determined after careful consideration and consultation, highlighting the complexity and risks involved.
Government Response
Deferred
HM Government
Deferred
1.1 The government agrees with the Committee’s recommendation. Target implementation date: to be advised 1.2 To rebuild dentistry in the long term, work on the government’s ambition to reform the dental contract with a shift to focus on prevention and the retention of NHS dentists is underway. There are no perfect payment models and careful consideration needs to be given to any potential changes to the complex dental system so that genuine improvements for patients and the profession can be delivered. There are risks of destabilising the current 20 system, and a realistic timetable for the introduction of a new contract will be determined by the scale of changes under consideration and following consultation. 1.3 The government is continuing to work with the British Dental Association and other representatives of the dental sector to deliver the shared ambition to improve access to treatments for NHS dental patients, whilst at the same time, considering what other improvements can be made to incentivise the workforce to deliver more NHS care. The government recognises the importance of working with the wide range of dental care professionals, commissioners and importantly, patients and the public, to inform a new and improved dental contract for England, upon which the government expects to consult publicly. 4.11 Where there have been changes to individual practice funding levels this will have been because of either: • practices asking to reduce their NHS commitment, or • ICBs taking steps to release monies from persistently under-delivering contractors to enable these monies to be used to buy care from providers who can deliver. 4.12 Cash reductions could also be possible where ICBs are recovering funding paid for activity which was not delivered in the previous year. All these scenarios support access to dental treatment and best value for public money.