New NHS dental contract – what to expect

There have been rumours for the last few years about how the NHS dental contract is going to be revolutionised, with varying degrees of suggested change. Action has however now been taken to put some of these theories into action to test potential new forms of the NHS dental contract.

Prototype contract

A scheme has been put in place where practices are piloting new dental contracts. There are two payment mechanisms being tested by the prototype contract with a mix of capitation and activity-based payments.

Why do we need a new form of contract?

The proposed new contract has been the direction of travel for some time with the intention of “improving access and oral health at an affordable price”. One of the key elements of the proposed new contract is that it is more focused on providing care pathways for patients for them to take greater responsibility for their own oral hygiene, whilst still having access to treatments on the NHS which are clinically appropriate.

What is the new contract likely to look like?

The key feature of the new contract is the blended remuneration system with the split between capitation and activity. It is understood that practices will keep the same UDA contract value and continue to be paid 1/12th each month. However, up to 10% of the contract value is at risk if capitation and activity levels are not met. If expected activity and capitation is exceeded then, up to an additional 2% of the contract value may be paid. Capitation deals with the expected number of patients on a practice’s list at the end of the year. Activity focuses on an expected minimum level of activity. This includes an adjustment on the basis that prevention takes time and fewer treatments will be delivered as a result.

There are two different models of remuneration being

  • Blend A – the capitation element will cover band 1 courses of treatment and urgent/charge exempt courses of treatment delivered to patients. The activity element will cover band 2 and 3 treatments to patients – as well as urgent/charge exempt courses for patients not on the practice’s list.
  • Blend B – the capitation element will cover band 1 and 2 courses of treatment to patients and urgent/charge exempt courses to patients. The activity element will only cover band 3 courses of treatment to patients – as well as urgent/charge-exempt courses for patients not on the practice’s list.

Additionally, there is a Dental Quality and Outcome Framework (DQOF) to monitor the quality of service being provided. This will not, at this stage lead to any financial adjustments but it may do in the future.

The DQOF monitors the following:

  • Patient safety – 100 points
  • Clinical effectiveness – 500 points
  • Patient experience – 300 points
  • Data quality – 100 points

How to approach the new contract?

The new contract provides for a different delivery of care that requires an oral health assessment and review, as well as a preventative treatment plan. This may therefore require a change in your current methods of working. Some practices have looked at increasing the skill mix of their team, and others have focused on improved patient communication. Practices will need to consider how they will best deliver services to their patients to meet the new contract requirements.

What’s next?

The prototype scheme will continue and another wave of practices will join in January 2019. The intention long term is for a gradual roll out of the new contract over the next couple of years.

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