An update from the Genera l Dental Practice Committee (GDPC) of the BDA – Chair John Milne –
Care Quality Commission (CQC) has now employed dental advisors.
Area Teams are lean
Local Professional Networks (LPN) have very small resources. Lack of resources means limited
effectiveness. They are a talking shop at the moment.
Reducing contract values constant – high targets, low values.
Department of Health (DH) are responsive to the feedback coming out of the pilots. Focus on
prevention.
The Department of Health needs to flesh out the new contract and spell out a “framework” that will
work.
There is a mismatch between the high dental workload and the dental budget (£2.4 billion). The
NHS dental budget is not going to go up.
The GDPC / BDA are working for a guaranteed transitional income to the new dental contract.
There needs to be clarity for patients and an honesty about what NHS dentistry is to provide.
Henrik Overgaard-Nielson – John Mine’s number two in the negotiations with the Department of
Health and Chair of Hammersmith LDC – stated to the conference that he personally believed that
the GDP can currently override the pilot software on the clinical pathway but that going forward, he
personally did not believe this would be case, Henrik believed the Department of Health wishes
GDPs to follow the algorithms full stop. Henrik believed there would be financial penalties for GDPs
who did not follow the algorithms.
Ian Gordon of the North Yorkshire LDC stated that the LDC has been asked for advice by the area
team on the out of hours service, orthodontics and oral surgery, in each case their advice had not
been followed.
Ian Gordon stated the area team wished a further delay on the LPN, lack guidance and things taking
longer and longer and still nothing is happening. He stated the LPN is not adequately resourced
(£40,000 for dentistry out of a £120,000 overall budget for GPs, opticians and dentistry - for the LPN
for North Yorkshire, East Yorkshire, Hull and North Lincolnshire).
Ian Gordon stated LDCs should have representation on LPNs and full voting rights.
In some cases the local consultants in Public Health have been made the Chair of the LPNs, on other
LPN’s the area team dental representative!
The area team covering Worcestershire had put in an email, that it did not want LDC representation
on the LPN in its area.
Ministerial address to the LDC Conference – Parliamentary Under-Secretary of State for Health
Earl Howe –
Earl Howe stated standard operating practices were be created England and Wales, so it would be
the same, wherever you are located.
Bullying in the NHS – No case for this in the NHS – unacceptable, full stop. Investigations must take
place but in the right way with dentists been supported. This was stated in light of the dentist in
Leeds who has recently committed suicide.
Wish a culture of support, not confrontation, work together
Task group set up by NHS England and Public Health England to look at how to give dentistry to the
vulnerable and hard to reach groups.
The focus needs to be on quality – the right quality care, at the right time by the right team.
Clinical leadership vital.
LPN’s are there to support area teams and provide clinical dental leadership.
The new contract – Clinical Pathways – needs to be a culture change – dentists need to be fully
engaged.
LDCs to work with area teams
Lessons from the past is why the time is been taken with the new contract and the pilots – the new
contract needs to be robust and sustainable.
The pilots are basically right.
The focus on the pilots is on outcomes – prevention via the oral health assessment with care based
on the needs of the individual.
Second wave of the pilots - now 90 practices - Patient care and IT vital to the new proposed
contract. Earl Howe stressed decisions on patient care will not be driven by the computer, supports
dentists clinical freedom.
Earl Howe said IT support has to be in the mix for the new contract but said he could not give any
specifics for maybe a year.
Via the pilots, they have learned to stop / reduce the long waiting list for Interim Care Visits (ICM).
Needs to be a frank exchange when contract values are discussed – both current contracts based on
UDAs and the new contracts.
Good oral health vital to address inequalities.
Dentists need to be fairly rewarded and the investment they put into their dental practices needs to
be recognised versus the need for value for money, clinical outcomes and the current economic
climate.
Earl Howe stated there was a good relationship between the government and the leadership in
dentistry.
Earl How informed at the conference that Alison Benton, the dental lead for London, does not
believe there will be an LPN for London due to a lack of LPN funding.
The Future of Associates - An associates point of view – Member of the BDA’s Young Dentist
Committee - Michael Lessani –
Associates must up skill to level 2 to justify the current income they currently command under the
new contract – endodontics, periodontics, sedation, oral surgery, restoration (advanced level for this
last one)
Unemployment now in dentists
UDA auction – by principals with associates – One case of £4 per UDA, another of £5 per UDA!
Fraud risen
Costs of training rising.
New dentists / dental graduate 2008 – 60% of dentists mixed – 10% in Hospitals
2010 – 35% of dentists mixed – 25% in Hospitals
Corporate here to stay- most associates in the corporate have a daily target, in some cases if not
met, financial claw back.
One man bands / small dental surgeries cannot compete against the corporate e.g. for tenders /
presentations
Direct access a threat to associates
Pilots – 4 areas of concern –
Status
Need to get enhanced and advance skills
Market forces
Job has changed
Universities need to do more to prepare dental students for the changing / changed dental world.
Need business skills to be taught.
The Future of Associates – the view from corporate practice – CEO of Oasis Dental Care – Justin
Ash, representing the Association of Dental Groups –
Justin Ash, CEO of Oasis Dental care was speaking on behalf of –
Oasis
IDH
Genix
Rodericks
BUPA
Portman Healthcare
Justin Ash previously ran Lloyds Pharmacy (link to dentistry and what happened there), before that
KFC and Allied Domeq.
Justin Ash said his previous career experience gave him the necessary insight to running multi site
locations.
Oasis – currently 205 practices, 850 dentists
Oasis has 6 pilots .
Oasis is currently 60% NHS, 40% Private
He said that Oasis had a 99% customer satisfaction level (!?)
The current dental market split –
2010 – corporate 7% independents 93%
2011 – corporate 8% independents 92%
2012 – corporate 9% independents 91%
2022 – corporate 30% independents 70% - Oasis’s prediction
Justin Ash predicted in 25 years time (2038) dentistry will be 50% Corporate and 50% Independent.
Workforce split at Oasis –
57% Male, 43% Female – Female figure rising each year.
66% of dentists UK trained
34% of dentists trained overseas
35 year old dentists – 78% NHS, 22% Private
35 to 50 year old dentists – 53% NHS, 47% Private
50 Plus year old dentists – 22% NHS, 78% Private
Over 200 dental practices sold in England and Wales each year.
Dentists falling into three life stages – associate, principal, associate - if selling their practice and
staying on.
What Associates Need –
Great Communication skills
Prepared to work in a multi skilled team – dentists and therapists + dentists enhancing their skills –
periodontics, endodontics, implants, sedation, oral surgery, advanced restoration
Excellent Record Keeping - In view of the “climate” and it is only going one way – CQC etc...
Willingness to adapt to change and keen to self develop
What does Oasis’s management provide –
Quality / audit / cross infection
Develops the business and the associates (Oasis holds an annual conference for its associates)
Marketing
Oasis currently loses 2 to 6 associates per week – mainly dentists who came from overseas and are
returning home.
How Justin Ash sees the future of dentistry –
More age diverse
Wider experience levels
More NHS
More Private
More specialists
More dentists who are trained in the UK
More pressure with the new contract, regulation and new legislation
More competition – dentistry itself a market place in the form of patients / customers
More completion – The more talented dentists will prosper
Practices need to support and develop dentists and give them the skills to go forward.
A question from the floor asked for Justin Ash’s view on a minimum wage / guaranteed income for
dentists – Justin Ash’s response was he did not think this was practical, goes against EU / UK
legislation regarding a free market / restrictive practices and the Office of Fair trading would not
wear it.
Oasis conducting a big drive towards endodontics – looking at putting a dentist who can do
endodnotics in every Oasis practice.
Direct Access – Justin Ash believed patients would understand it, what the patients were concerned
with was the overall care and service they get from Oasis (in effect he was saying they buy into a
consistent brand e.g. Virgin not necessarily an individual dentist).
He also said in relation to direct access – no fewer visits to the dentist and no less associates – not
sure how the circle is squared here.
Asked about self employed status – Justin Ash said it was too early to comment.
Asked how dentist would be remunerated under the new contract at Oasis – again said, it was too
early to comment.
Eddie Crouch spoke to Justin Ash – he said there was one Oasis dental practice near him. Since 2006
it had had 62 different performers / dentists. Justin Ash responded by saying that the turnover of
associates at Oasis was 9% per year. The 9% was mainly made up of overseas dentists leaving after
three years to go home. The rule of thumb he said was 1 dentist leaving per practice every 18
months.
Justin Ash stated each practice in the group needs to be able to financial stand on its own.
Justin Ash said Oasis like the new contract based on capitation (their financial backers will, it is
guaranteed income stream for the first three years).
He stated dentists may be incentivised around the care pathways
Question time: Ask NHS England – Head of Primary Care, NHS England, David Geddes –
David Geddes confirmed that currently £2.4 billion is spent on NHS dentistry.
Jim Lafferty of Sheffield LDC - asked David Geddes about the LDC Levies which have not been paid
out by the BSA on the instructions of the area teams. David Geddes said the delay will be corrected
within the week.
David Geddes was asked if dentists would be paid for treating children in schools. His reply was a
task group had been formed, Collette Bridgeman, the Consultant for Public Health for Manchester is
co-ordinating, the three schools she has a pilots in Rochdale are being used. (The Brush Bus Partners
submitted their evidence on Monday 3rd June). This would form part of the new pathways been
developed as part of the proposed new dental contract.
The focus will be on outcomes (results) in the proposed new dental contract, use of the dental team
– dental nurses and dental therapists – using the dental software as an aid / guide.
Responsibility for Maxfacial will move from the NHS England to the local CCG’s (currently
responsibility is split between the two for commissioning these services).
He said there was pressure to reduce UDA values to make savings and no new dental services are
been commissioned.
David Geddes informed the conference, that one large dental laboratory group working with one
dental corporate had gone bust
Some area teams desire one LDC levy charge e.g. where there are 4 LDCs liaising with one area team
– no decision made at this time on this / uniformity.
David Geddes stated the current position is a “holding operation” / wait and see until the end of July
when a new national agenda will have been finalised and sent to all area teams, so they can
implement a national agenda.
No LDC will be forced to merge with another LDC, so there is one LDC to mirror the area team’s
geographical area.
David Geddes said he wished LDC’s to have details of dentists in their geographical area.
David Geddes stated there where massive differences inequalities, “for example, an area I know best
as a GP in York (he works one day a week as GP), is the massive differences between Harrogate and
Hull.”
David Geddes said the future of dentistry is not top down.
David Geddes was asked about LDC’s having a place on LPN’s with full voting rights. His view was
that not many people were coming forward to be on LPN’s and even though there could be a conflict
of interest, this could be managed, just as it is managed with GPs sitting on CCG boards. Members of
LPNs should be appointed on the basis of ability, credibility and be able to take their fellow GDPs
with them. The GDPs appointed to the LPN’s needed to go through NHS jobs / application process.
Other information –
There was discussion over time bared i.e. 3 years for the new proposed contracts – as PDS contracts
are now – NHS England stating why dentists should not be any different from the NHS! It was
highlighted that dentists with an NHS dental contract are not having their infrastructure paid for by
the NHS / taxpayer, the infrastructure is paid for by the dentist, big difference, say from GP’s.
If the proposed dental contract is to be time bared –
Banks will not lead to dentists to invest
Dentists will not invest because the banks will not lead to them + why invest in something which is
no longer part of your pension fund
Practice values will fall
Employment security for both associates and employees will fall
There was discussion about a minimum UDA value – Henrik Overgaard-Nielson – John Mine’s
number two in the negotiations with the Department of Health and Chair of Hammersmith LDC –
pointed out that the minimum UDA value in this case / situation will quite likely become the
maximum UDA value. About 50% of dentists could end up with a lower UDA value when a national
average UDA value is arrived at.