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Dental Tribune United Kingdom Edition

W ho remembers the General Dental Ser- vices (GDS) con- tracts? Yes, for some people the painful memories are still there! These were introduced to take effect from April 2006 and heralded the new local commissioning arrangements for NHS primary dental care services. There were also new contracts for dentists in Per- sonal Dental Services (PDS) pilots making the transition to GDS contracts. For those pro- viding services such as ortho- dontics, there were substantive time-limited agreements – nor- mally a five-year PDS Agree- ment, which is different from the new PDS+ Agreement. Towards the end of 2009, the DH introduced a new mod- el contract called the PDS+ Agreement. Many dentists and dental associations were con- cerned that this new agree- ment was a shorter-term con- tract than previously, that it favoured the PCTs and required managements systems likely to be beyond the resources of small practices and even larger corporate ones. Updates to this draft agreement followed in early 2010 – most notably to the payment bands for key perfor- mance indicators (KPIs). Since their introduction in 2006, dental contracts have of- ten been criticised. Some den- tists claim they encourage an ethos of ‘drill and fill’ in order to claim the Units of Dental Activity (UDAs) required un- der the contract. Some even suggest that it has encouraged ‘informed neglect’ – which are not words to be used lightly. However, when an investiga- tion by NHS Protect subse- quently uncovered £70m a year of fraudulent claims it was the death knell for these contracts. In 2010 the government an- nounced it would pilot three different models to help de- velop a new national NHS den- tal contract. Dental practices with existing GDS contracts or PDS agreements were in- vited to apply to become a pi- lot in December 2010. From the applicants who met the criteria, a selection was made in order to reflect the diverse range of the practices across England, in terms of ‘rurality’, size, population demographics, and so forth. There was also a mix between corporate, in- dependent and single-handed practices. Seventy pilot practices went live in the summer of 2011, al- though not all at the same time – a staggered approach allowed flexibility to resolve any details with the PCT and the practice before signing the agreements, and gave the national team the capacity to support them through this process. Support is provided via a national team that includes the Department of Health, NHS Dental Services and oth- ers. Clinical training for dental teams on the care pathways and support on implementing and using the software have been provided, as well as a range of events for both PCTs and practices, a dedicated re- gional support lead and an online helpdesk and resource network. While the agreements make changes to the way dentists work and what they’re paid to do, they continue to receive payments and contract infor- mation from NHS Dental Ser- vices, and PCTs remain as the commissioner and contract holder with the practice for the next few months until they no- vate to the NHS Commission- ing Board. The new agreement would be designed to reward dentists for ‘the continuity and quality of care provided to patients, promotion of oral health and preventative measures as op- posed to the number of units of dental activity undertaken’. At the same time, the dental out- comes and quality framework (DQOF) was launched to meas- ure the quality of work carried out under the proposed new contract. According to the DH: ‘It will be underpinned by the use of a standardised oral health as- sessment and the development of a comprehensive set of ac- credited clinical pathways’. At the time of writing, the DH has just added 29 new practices to join the 70 already on the pilot scheme. Following assessment of the experiences of the practices on the pilot scheme and a period of consultation, legislation will be brought before Parliament and, if approved, the new den- tal contracts are proposed to commence from April 2014. However, I have been hearing recently that 2016 now looks more realistic in terms of im- plementation. Whether the Coalition will allow one of its pledges to remain unfulfilled going into the next General Election remains to be seen. In the HM Government Mid- Term Review – Programme All change on the NHS contracts front Amanda Atkin relates the ongoing saga of NHS dental contracts and advises on good housekeeping you should undertake ‘In 2010 the govern- ment announced it would pilot three different models to help develop a new national NHS den- tal contract’ Core pathways for patients form part of the pilots March 25-31, 201322 Practice Management United Kingdom Edition