NHS dentists struggle to fulfil contracts amid pandemic

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Government lowers minimum units of NHS dental activity, scraps standard operating procedure

Many NHS dentists have been delivering above 100% of the UDA threshold as they work to clear the vast backlog in patient treatment, but others have struggled. (Image: sirtravelalot/Shutterstock)

LONDON, UK: The National Health Service (NHS) says that despite an increase in oral healthcare provision there was persistent variation in the activity levels of UK dental practices in January and February. The income protection threshold for minimum units of dental activity (UDAs) for the fourth quarter of 2021 has therefore been lowered to 75% from 85%, and the government has removed from its guidance the dental standard operating procedure (SOP) that was introduced during the pandemic.

In a bulletin to primary care dental contract holders, Chief Dental Officer for England Dr Sara Hurley and Director for Dentistry, Community Pharmacy, Optometry and the NHS Standard Contract Ali Sparke said that the impact of the omicron variant of SARS-CoV-2 had prevented some dental practices from achieving the 85% income protection threshold. Lowering the minimum UDAs for the fourth quarter was an effort to support clinics that have struggled most in the current operating environment, they said. The conditions for income protection remain unchanged, and practices delivering NHS dental services must still use 100% of their contracted capacity to provide NHS dental services, the bulletin read.

“Contractual requirements have always been designed to secure safe levels of patient access and reduce financial penalties for practices for reasons that may have been outside of their control,” Dr Hurley and Sparke commented, adding that a review of data from the fourth quarter had resulted in the lowering of the UDA threshold.

“[It] is critical those contractors who are not already there make progress to return as quickly as possible to the pre-pandemic activity levels” – Dr Sara Hurley and Ali Sparke

In March, the NHS announced an additional £50.0 million (€60.4 million) in funding for the creation of up to 350,000 new appointments, and many NHS contractors have been delivering above 100% of the threshold as they struggled to clear the vast backlog in patient treatment that accumulated as a consequence of the pandemic. Others have struggled however. Dr Hurley and Sparke said: “[It] is critical those contractors who are not already there make progress to return as quickly as possible to the pre-pandemic activity levels. Our current plan is for a return to normal contracting arrangements from July 2022, and we will confirm these arrangements separately. However, we have agreed a further exceptional period of support for Q1 at 95% for dental contractors only.”

Providers of orthodontic care have rebounded more quickly than general dentists. Normal contract volumes therefore remained in place for NHS orthodontic service providers.

Primary care dental contract holders were also informed that the SOP guidance has been removed. Dr Hurley and Sparke said: “As the NHS moves in line with the government’s living with COVID-19 strategy, we will now remove the dental SOP, subject to no further significant changes to [infection prevention and control] guidance.”

The contract and guidance updates have been provided at a time when many dentists remain expectant of long-awaited changes to NHS contracts. The significant challenges that UK dental professionals have faced since the beginning of the pandemic have resulted in calls for reform, and Dr Hurley said in early April: “We all recognise that the UDA has run out of road. But I don’t believe that NHS dental care has.” She added: “Whilst I do think we find ourselves in an important time of change, I am going to need to be realistic. If dental system reform is easy, we would have been done already.”

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