New system of targets in the UK: a step backwards for dentistry?
LONDON, UK: Dentists in England currently receive their former National Health Service (NHS) contract value provided they spend the same amount of time working on providing NHS care as they did before the COVID-19 pandemic took hold, slowing down or completely halting all business operations. However, the new system of targets imposed by the UK government states that dentists who are unable to deliver 45% of their pre-pandemic dental activity will face financial penalties plus potential breach of contract consequences. Naturally, dental professionals have opposed the new contractual arrangement, claiming that it threatens the viability of many practices and undermines patient care.
Since the UK is still in lockdown, it comes as no surprise that, according to a recent poll, patients continue to cancel their appointments and are reluctant to seek routine care. The country has also recently seen the emergence of new SARS-CoV-2 strains which will eventually increase the rate of infection and possibly slow down the distribution of COVID-19 vaccines.
The new targets, which were imposed on New Year’s Day, are aimed at restoring dental services in the UK. They demand that all dentists retain their pre-pandemic patient volumes. However, this seems impossible, given the existing COVID-19 restrictions and rules.
Under the new contract, dentists who fall below 36% of the activity target will have to return the majority of their funding provided by the NHS for the period from 1 January to 1 April 2021. To the disappointment of dentists, the new targets do not take into account visits that take place virtually, such as telephone triage. According to the BDA, a staggering quarter of all activity occurs over the phone. This way of stimulating activity helps maintain contact with the patients and protects both parties from possible infection.
The BDA has expressed its concerns over the new targets, claiming that they are unattainable for the majority of dental practices. According to the association, approximately 41% of dental practices in the UK are currently operating below 36% of their targets, which makes up almost half of the total workforce.
“Cancellations are surging while increasing number of staff are sick, self-isolating or struggling to secure childcare. Targets that were always hard to justify are now impossible to deliver, leaving scores of dedicated NHS practices set to go to the wall,” Dr Dave Cottam, chair of the BDA’s General Dental Practice Committee, said in a press release.
Shifted focus—prioritising non-urgent care over urgent cases
Under the new system of targets, some dentists feel as if they are being forced to abandon patients who are in pain and urgently need treatment and, instead, prioritise low-risk cases, since this means attracting more patients to the clinic and reaching the targets more quickly. However, such an approach is considered by many to be unsafe.
“Ministers are instructing dentists to churn through routine appointments against the clock, rather than deal with a huge backlog of urgent cases,” Cottam noted. “Dentists wanting to do the right thing by their patients will now be punished for it. To stay financially viable, we are being made to choose the worried well over people in pain,” he continued.
“This logic has no place in a 21st century health service in the middle of a global pandemic”
— Dr Dave Cottam, BDA
According to the BDA, over 19 million NHS appointments were missed in England in 2020. To meet the targets, dentists now have to increase either patient volume or practice revenue. One way to achieve that could be by reducing the fallow time restrictions, which can now be done by installing improved ventilation systems. However, as Cottam noted, most practices cannot bear the considerable cost of upgrades to the ventilation system and are desperately counting on government support.
“Official restrictions slashed our capacity, yet there is no hint of investment to help us secure equipment that could get more patients through our doors safely,” Cottam said. “Practices struggling to stay afloat will face huge financial penalties chasing impossible numbers. This logic has no place in a 21st century health service in the middle of a global pandemic.”
On 14 January, members of parliament gathered to discuss the impact of COVID-19 and the introduction of activity targets for dental services. Like many dental professionals, most of them strongly opposed the new system of targets and urged the government to provide active support for private dental practices, including business rates relief, funding to improve ventilation systems and reduce fallow time, and priority access to COVID-19 vaccines.