The dental community are surprised this week that despite political chaos details of NHS contract reform were indeed provided prior to parliament’s summer recess. Just.
As predicated it is a not a major shake up. More of a tweak to how things are working. Some points are likely to be beneficial but I would express significant concerns regarding the section entitled ‘Making Better Use of Resources”.
In the lifetime of the GDS contract it has always been possible for the NHS to reduce or withdraw the contract for practices which have a history of breach notices. From experience this is actually only done unilaterally by NHS England in fairly extreme circumstances. Most practices experiencing a reduction have done this voluntarily. Voluntary reductions remain an option.
The letter produced last week sets out that the NHS will unilaterally reduce an NHS contract to the highest performed level in a three year period. Taking into account 2019/2020 but missing off the two pandemic years and starting again in 2022/2023. It is a formalisation of what could already happen and makes it clear how it will be done.
My main concern with this plan to unilaterally reduce contracts is that, in my experience, when a practice is underperforming it is not for want of trying. Practices underperform for a variety of reasons but the stand out issue is an inability to recruit rather than a shortage of patients.
Recruitment issues can be particularly prevalent in deprived or isolated communities, meaning a GDS contract in less affluent areas can be more likely to underperform.
Consider, for example, an island community with a recruitment issue. Nearly every GDS contract in that island community may be underperforming. Is the solution to the backlog of patients needing treatment on that island to unilaterally remove unperforming UDAs?
The reality is that if this starts to become enforced unilaterally it is more likely to be affect deprived, harder to recruit into, communities. It is robbing from the poor to give to the rich.
