Overview and Scrutiny Committee Herts 2007 The New Dental Contract 12 months on Sue Gregory Consultant in Dental Public Health

Primary Dental Services (2003 Act) PCT has a duty to provide or secure primary dental services to the extent it considers reasonable through: GDS contracts; PDS contracts; or provides them itself

Changes PCT dental commissioning from April 2006 Changes in patients’ charges –Simpler (3 not 400) –Avoids confusion on private/NHS boundary –Breaks link between dentists’ remuneration and charges Money devolved on practice base, not by address of patient

GDS contract/PDS agreements Only 2 types of contract, GDS/PDS agreement GDS – contractor required to provide a range of dental services set out in the NHS(GDS contracts) regulations 2006, known as “mandatory services” PDS – practices not providing full range of mandatory services (incl ortho) under PDS agreement

Mandatory Services All proper and necessary care and treatment which includes: - the care which a dental practitioner usually undertakes for a patient and which the patient is willing to undergo, including advice and planning of treatment - treatment, including urgent treatment -..the referral of the patient for advanced mandatory services, domiciliary, sedation…..

Care and Treatment Examination Diagnosis Preventive care and treatment Periodontal treatment Conservative treatment Surgical treatment Supply and repair of dental appliances Radiographs Supply of listed drugs Issue of prescriptions

Units of dental activity Contract level derived from conversion of Dental Practice Board recorded activity over “test period”October 04 to September 05 Less 5% 2% tolerance

Patient Charge Bands-Band 1 £15.90 This charge will include an examination, diagnosis and preventive advice. If necessary, this will include X-rays, scale and polish, and planning for further treatment. Urgent and out-of-hours care will also cost £15.90.

Band 2 - £43.60 This charge includes all necessary treatment covered by the £15.90 charge PLUS additional treatment such as fillings, root canal treatment or extractions.

Band 3 - £194 This charge includes all necessary treatment covered by the £15.90 and £43.60 charges PLUS more complex procedures such as crowns, dentures or bridges.

Band 1 course of treatment (excluding urgent treatment) 1.0 Band 1 course of treatment (urgent treatment only) 1.2 Band 2 course of treatment 3.0 Band 3 course of treatment 12.0 Type of course of treatment Units of dental activity provided Units of dental activity in respect of banded courses of treatment

Why do dentists leave the NHS? Fed up with the system - bureaucracy - treadmill, want less patients and more time Uncertainty Lack of trust in NHS

Post 2006 PCTs will move from historically based contracting to commissioning locally sensitive services Local variation of needLocal flexibilityDevelopment of Commissioning (rather than contracting)

April 2007 outturn for 06/07- PCTs (incomplete data) PCTUDA deliveryUDA deficitPCR deficit 193.5%36,033£549, %9,303£243, %71,073£1,605, %72,627£532,452

April 2007 outturn for 06/07- Providers (incomplete data)

Provider Outcomes Outturns against targets not evenly spread Full range from under to over Some data still missing Child only contracts more likely to under perform

Changes in Practitioner Behaviour Profiles of banding have changed - reduced band 3 - data from laboratories confirms significant reduction Less likely to undertake long or complex treatment plans Increasing referrals But contract value unchanged

The balance of the market A managed market All NHS growth under control of PCTs Influx of foreign dentists Dentists have less flexibility where they work Rejected contracts/retirement contracts sought after ?Enhanced goodwill

The private/NHS interface Mixing - ? Increase Private practices seeking specialist contracts Local commissioning add-ons: eg OOH Struggling practitioners- ?better alternatives for these dentists within a managed market

Salaried Dental Services Currently see special needs groups Need to maintain flexibility of service to meet patient needs within an integrated dental budget - Other areas of specialist care - Access

Primary/Secondary/Tertiary Interface – Integrated Commissioning Max 18 week waits for hospital treatment Payment by results and tarriffs More 2ndary care in the 1ary care setting Practice Based Commissioning

Towards 2009 and beyond Communication Negotiation Corporates and Limited Companies “Basket of Indicators” Opportunities/threats Oral Health Commissioning Group