pdsblog

If you want to keep those letters after your name, you need to protest this with the GDC.

We had our review today. Two people from the PCT who I had never met before came to tell us that we were 1000 UDA's short, and they wanted to work with us to make this up. After discussion it became clear that they had no knowledge of our UDA's being inflated above those stated by the BSA, and they seemed quite taken aback by our forcefull presentation of this fact. Interesting meeting, and the guy actually gave the impression of being very reasonable.

They were also of the opinion that we could be claiming UOA even though we were told originally that we could not. We are told that the Ortho reviews that we have done and not claimed may make up the shortfall, and that the PCT will "let us know" if this is the case or not.

To clawback PCTs must carry out an annual review before sending out
such notices and that letters stating arrangements may not be
construed as formal breach notices.

Colleagues also have the opportunity to appeal such decisions via the
NHS LA before payments are taken.

If monies are deducted without agreement, late payment notices can be
issued against the PCT which allows claiming of interest on money
with held.

PCTs must defend any clawback as being reasonable and therefore if
you feel you have carried out the correct amount of dentistry for the
contract value irrespective of the UDAs delivered the PCT must listen
and act reasonably.

347. If there is a dispute between the PCT and the Contractor in
relation to a contract sanction that the PCT is proposing to impose,
the PCT shall not, subject to clause 350, impose the proposed
contract sanction except in the circumstances specified in clause
348.1 or 348.2.

348. If the Contractor refers the dispute relating to the contract
sanction to the NHS dispute resolution procedure within 28 days
beginning on the date on which the PCT served notice on the
Contractor in accordance with clause 344 (or such longer period as
may be agreed in writing with the PCT), and notifies the PCT in
writing that it has done so, the PCT shall not impose the contract
sanction unless-

348.1. there has been a determination of the dispute pursuant to
paragraph 56 of Schedule 3 to the Regulations and that determination
permits the PCT to impose the contract sanction; or

349. If the Contractor does not invoke the NHS dispute resolution
procedure within the time specified in clause 348, the PCT shall be
entitled to impose the contract sanction forthwith.

350. If the PCT is satisfied that it is necessary to impose the
contract sanction before the NHS dispute resolution procedure is
concluded in order to-

the PCT shall be entitled to impose the contract sanction forthwith,
pending the outcome of that procedure.

The Committee will hold an inquiry into NHS dental and orthodontic
services. The inquiry will examine both General Dental Services (GDS)
and Personal Dental Services (PDS). The Committee's inquiry will
examine the principles underlying the reforms to dental services,
which took effect in April 2006, and the extent to which the changes
brought about have been consistent with these principles.

The Committee's inquiry will focus particularly on the impact of the
reforms on:

. Numbers of NHS dentists and the numbers of patients
registered with them [THERE IS NO REGISTRATION ANYMORE YOU BLOODY NUMPTIES];

. Numbers of private sector dentists and the numbers of
patients registered with them;

. The extent to which dentists are encouraged to provide
preventative care and advice;

The Committee will also consider, as part of its inquiry, the
Department of Health's report, NHS Dental Reforms: One year on, which
reviewed the first year's operation of the new contracts.

Organisations and individuals are invited to submit written evidence.
Written evidence should if possible be in Word or rich text format-
not PDF format-and sent by e-mail to healthcommem@parliament.uk. The
body of the e-mail must include a contact name, telephone number and
postal address. The e-mail should also make clear if the submission
is from an individual or on behalf of an organisation. The deadline
is Thursday 6 December 2007.

Submissions must address the terms of reference. They should be in
the format of a self-contained memorandum and should be no more than
3,000 words. Paragraphs should be numbered for ease of reference, and
the document must include an executive summary. Further guidance on
the submission of evidence can be found at
www.parliament.uk/documents/upload/witnessguide.pdf .

Submissions should be original work, not previously published or
circulated elsewhere, though previously published work can be
referred to in a submission and submitted as supplementary material.
Once submitted, your submission becomes the property of the Committee
and no public use should be made of it unless you have first obtained
permission from the Clerk of the Committee. Please bear in mind that
Committees are not able to investigate individual cases.

The Committee normally, though not always, chooses to publish the
written evidence it receives, either by printing the evidence,
publishing it on the internet or making it publicly available through
the Parliamentary Archives. If there is any information you believe
to be sensitive you should highlight it and explain what harm you
believe would result from its disclosure; the Committee will take
this into account in deciding whether to publish or further disclose
the evidence.

For data protection purposes, it would be helpful if individuals
wishing to submit written evidence send their contact details in a
covering letter or e-mail.

Evidence sessions are likely to commence after the Christmas Recess
and a later press notice will give details of these.

1. The Membership of the Committee is as follows Rt Hon Kevin
Barron MP (Chairman) [L], Mr David Amess MP [C], Charlotte Atkins MP
[L], Ronnie Campbell MP [L], Jim Dowd MP [L], Sandra Gidley MP [LD],
Dr Doug Naysmith MP [L], Mike Penning MP [C], Mr Lee Scott MP [C], Dr
Howard Stoate MP [L], Dr Richard Taylor MP [IND].

Responding to the announcement of the Comprehensive Spending Review
today, the British Dental Association has called on the government to
ensure that funding for NHS dentistry keeps pace with funding for other
parts of the NHS.

Despite the unprecedented investment in the National Health Service, the
British Dental Association estimates that the proportion of NHS funding
allocated to NHS dentistry has actually fallen from about 3.1 per cent
in 2002-03 to 2.8 per cent in 2007-08.

And in the period 1990-91 to 2003-04, according to the National Audit
Office, overall NHS funding per capita increased by 75 per cent.
Spending on high street dentistry per capita during the same period
increased by only nine per cent.

"Investment in NHS dentistry remains inadequate as the government itself
acknowledges that around two million people who want to access NHS
dental care are unable to do so.

"If people are to get the NHS dental care they want, then the level of
spending on dentistry must catch up with the investment in the rest of
the NHS.

"It's also crucial that primary care trusts, now responsible for
commissioning local dentistry, understand the history of underspending
which has seen dentistry lag behind other areas of health care. ”

Still have yet to hear from the PCT about our contract. one can only assume they are very busy. I suspect that it doesn't help that one of the key people is moving onto pastures new, which is a real shame because she was someone who displayed a real common sense approach.

Dr Lester Ellman
Chair, General Dental Practice Committee
British Dental Association
64 Wimpole Street
London
W1G 8YS

Your Proposal for a Contractual "Amnesty"
Thank you for your letter of 16th August 2007 and for the constructive meeting we had yesterday.
Both the British Dental Association and the Department have provided high quality guidance to dentists and PCTs on how year-end issues should be handled, including both over-delivery and under-delivery. You quite rightly point out that dentists were promised gross income (practice turnover) protection for the 3 year transitional period but this was clearly linked to maintaining broadly the same level of NHS commitment as identified in the contracts. I fail to see how agreeing to ignore contractual agreements and remunerating dentists,
across the board for services not provided would in any way improve services to patients.

The majority of practitioners have met their contractual requirements within the allowed 4% level of flexibility to carry forward work into the following year. To maintain contract value in the way you suggest would mean that practitioners who deliver only 80% of their contractual requirements would have higher net earnings than those who met the terms of their contract.

Turning to your request for an amnesty, it is important to be clear that significant under performance, i.e. where less than 96% of contracted services have been delivered, is and will remain, a matter for PCTs. PCT freedom to manage contracts locally is a core principle of the new system and we have no plans to change this.

The information you have collected from PCTs suggests they are in fact
choosing to make direct financial recovery in only a minority of the under
performing contracts. I realise this is a small sample but so far it supports the view that PCTs are taking a generally flexible approach to this first year. It is important to bear in mind of course that PCT decisions on individual cases have wider implications. If undelivered activity is not made up, the ultimate loss is to the NHS and to patients. A PCT may decide on an individual basis to absorb this loss but it is never a cost free option.

New King's Beam House
22 Upper Ground
London
SE1 9BW
Tel: 02076334144
Fax: 02076334127

Yours sincerely
Barry Cockcroft
Chief Dental Officer - England
Directorate of Commissioning & Systems Management

BDA news release

*NHS dental budgets under pressure***

Figures published today provide further evidence of the problems facing
the Government’s dental reforms, the British Dental Association (BDA)
believes.* * According to today’s figures patient charge revenue only
generated £475 million instead of the expected £634 million,* resulting
in a shortfall of £159 million in the dental budget.

The statistics show that 12 months after the introduction of the new
contract in England some primary care trusts (PCTs) are struggling to
fund dental treatments as the patient charge shortfall equates to just
over £1million per PCT.

Under the new contract, PCTs are responsible for commissioning NHS
dental services but the BDA is concerned that around a quarter of the
dental budgets they hold rely on revenue from patients charges.

The BDA Chief Executive Peter Ward said:

“Today’s figures underline serious flaws in the government’s new system
for providing NHS dentistry. We’re concerned that dental patients will
lose out as PCTs face this further squeeze on their budgets. We believe
that PCTs should receive their dental budgets in full to end this
precarious situation.

“This all adds to continuing, and unacceptable, uncertainty for NHS
dentistry.”

"A shake-up in NHS dentistry in England has failed to increase access to services, government figures show.

A Department of Health report showed 28.1m people had been to an NHS dentist in the previous 24 months.

This was 50,000 down on the figures on the eve of the changes in April 2006. The number of dentists in the system has also fallen.

Patient groups said dentistry needed urgent attention, but the government said it was on a more secure footing.

The new contract was meant to tempt more dentists to work in the NHS by paying them the same money for seeing less patients."

So we had a letter in June from the PCT saying they would be contacting us in July about our review. The letter came (along with the PCT monitoring toolkit) on the last day of July. Practices in Derbyshire have until 31st August to respond with the required info. Not difficult to put together if you have been doing your clinical governance and have your practice fully systemised of course :)

OK, today I was at the Challenge DOH summit in Birmingham, which actually went ahead this time. I am not actually convinced that anything concrete was achieved, although I do not know what the individual parties involved were hoping to get out of it.

One interesting thing that did come out was the way the dental labs have been affected by the new contract. There has been an almost 50% decrease in NHS labwork, which means NHS income to labbs has dropped by almost £300 million.

Is the profession really that stupid? Are we now focusing on supervised neglect, or were we massively over treating in oGDS. A few more pieces of info like this and we will most certainly lose the percieved moral high ground that we think we occupy. Talk about shooting yourself in both feet!!!!!!!!!

I wrote to the BSA a few days ago about the new look schedule, which is, let's face it, completely pants. I had a phone call from someoene there who informed me that it was nothing to do with them. They had been told to change the format by the DOH, and they have absolutely no say in it. Crazy times.

Firstly we have a story that I feel is long overdue (in that I expected it over a year ago) -

Remember that people will remember the headline of the article, more than the article itself. As i said, the agenda now seems to be unfolding. Slowly, but surely, the profession is now feeling the noose tighten. So let me ask you, do you still plan to stay in the NHS post 2009.

Remember, the TIMES is a Murdoch rag, and you should always put whatever it prints through that filter.

What an amazing hatchet job, without actually addressing the actual cause of the problem.

Mr. Lancaster: To ask the Secretary of State for Health (1) what the
(a) maximum, (b) minimum and (c) average value of a unit of dental activity is in England; [138922]

Ms Rosie Winterton [holding answer s 23 May 2007]: Data collected by the Department centrally does not identify the value of units of dental activity (UDAs) or provide a basis for comparisons of UDA values between primary care trusts (PCTs) or dental practices.

So basically, what Rosie is saying here is that government doesn't know its arse from a hole in the ground. How very reassuring.

One thing that is clear to me is that there is a propoganda war being waged against the profession in the press, and we are losing big time. It is only a matter of time before we get another Dispatches/Watchdog/Panorama special to really stick the boot in. But this again reflects what I have been saying. Our future does not lie in the NHS. And yes I can see a whole bunch of regulations that will shortly be unleashed upon Private practice, but that will be a small price to pay to remove yourself from the vice like grip of the UDA.

PublicationsPolicyAndGuidance/DH_074926

The BDA has issued a statement in response, from GDPC Chair Lester Ellman:

"We're disappointed that central additional funding is not going to be made available to compensate practitioners who will be faced with extra costs. Practitioners will therefore be expected to negotiate for the necessary funding with hard-pressed PCTs"

"From April 2009, the default position will be that the
previous contract value (and other contract terms) rolls forward.
Either party to the contract may propose a contract variation, and we
anticipate that there will be some circumstances where PCTs wish to
review contract values, but there will be no automatic requirement to
negotiate a new contract value"

"We recognise that this is not explicitly set out in clause 3.2(a), and we intend to produce guidance on this as soon as possible, so that PCTs and contractors do not proceed on the assumption that every contract has to be re-negotiated by 31 March 2009"

"We will then draw up and consult on a new SFE that will formally
govern the new arrangements from April 2009. The BDA has raised with
us the question of how to promote stability for contractors and for
the NHS under these arrangements, for instance by ensuring that
contract reviews do not take place at over-frequent intervals, and we
have agreed that we will look at this in drawing up a draft SFE."

In my recent newsletter I ranted about the fact that the large number of postgraduate courses advertised in the dental journals were either for cosmetic dentistry or implants. In my view, the demand for these treatments does not warrant the number of courses (many of which are of dubious quality). Not every practice can be a centre of cosmetic excellence, but every practice can have prevention as its underlying philosophy. Unfortunately, most practices still have Drill, Fill and Bill as their main philosophy. We may never know just how this will be affected by nGDS because there is now no DPB to collect the data. In my view, shutting the DPB will turn out to be one of the biggest mistakes this government made with the new contract...... that and destroying NHS dentistry.

The more of this scientific stuff you read, the more you realise how little the so called scientists actually know. One piece of research contradicts another. There is research coming out of America now that indicates Prions aren't the problem, they are just a by product of cell death caused by a, as yet, unrecognised virus.

The British Dental Association (BDA) has successfully supported a judicial review against the NHS Litigation Authority. The case, heard on 9 May by Mr Justice Goldring, concerned a dentist awarded a zero valued general dental services (GDS) contract by Hillingdon Primary Care Trust.

The dentist, who did not work for Hillingdon during the test year but was in contract at 31 March 2006, appealed against the PCT’s belief that it had absolute discretion to award the contract value it thought fit. The NHS Litigation Authority supported the primary care trust. The BDA then intervened in support of the dentist’s decision to apply to the Administrative Court for judicial review.

The Litigation Authority accepted that it had acted unlawfully by not taking into account information in its possession about the dentist’s GDS activity between October 2005 and March 2006. By a Consent Order the case has now been referred back to the PCT to award a contract value that takes account of the practitioner’s GDS activity and all proper considerations. Additionally, the dentist was awarded costs. Peter Ward, Chief Executive of the British Dental Association, said:

“We’re pleased to have been able to support our member achieve thishighly significant ruling. This demonstrates that, in cases where a dentist has no activity during the test period and where an unreasonably low contract value has been awarded, it’s possible to infer that a PCT has not had adequate regard to all the circumstances.”

Oh look, a new style schedule from the BSA. Not only is my partner still being classed as a performer (instead of a provider) despite being told numerous times, they have now made it difficult to determine just exactly how mucha performer should be paid. This is a classic example of total unmitigated incompetance.

It would appear that dentists are in the news again. Firstly we have the Daily Mail:

Not the most dental friendly piece of journalism, but then newspapers only write what they think their readers will want to read.

A bit better this one, and displays the reality that will be facing many practitioners due to under achievement of those lovely UDA's.

What we, as dentists have tim understand is something very simple. We are faced with an untried and untested system that quite frankly doesn't work. Our leadership is divided and, quite frankly, inadequate. We as individuals make noises about how we don't want to work in this system, and then we stab ourselves in the back by

If you want a satisfying, successful and profitable career in dentistry, then I am afraid that will very shortly not be possible within the NHS. You now have a true treadmill developing, and you need to be ready to get off before the chain is firmly placed around your throat.

On 26th April 2007, eleven of the twelve associations which represent the providers of primary dental care met in the Grand Committee Room at Westminster to debate dental policy, under the chairmanship of Dr Andrew Murrison MP, shadow Minister of Health. The single and significant exception was the British Dental Association which pulled out of the meeting at the last minute for reasons which are not yet clear

Now I don't know what is going on here, but it is safe to say that this will not improve the perception of the BDA. However, if you sniff the air, you can just detect the subtle whiff of divide and rule (don't forget, the Tories will shortly be in power).

Now, despite the fact that I feel the approach Challenge is taking to the nGDS/nPDS contract is differant to mine, I still feel they have a very important roll to play. As you know, my personal opinion is that dentists should be looking to leave the NHS. However, anything that can be done to clarify the present situation, and to strengthen the position of NHS dentists can only be good. This is why I choose to support challenge, even though I feel their end game is differant to mine (my hallucination is that they seem to be fighting to preserve and improve the NHS dental service with a view to staying in).

For nearly a year the three founder members of Challenge have funded running costs and the costs associated with getting Challenge off the ground.

Eddie Crouch, Ian Gordon and John Renshaw with your help have made Challenge an organisation that has been respected and noticed by the BDA and the Department of Health. We have made them listen to what you have told us.

As part of our planning we have organised a Summit in June in Birmingham where approximately 30 influential figures associated with the business of NHS Dentistry will meet.

The hope is that this Summit will unify an approach to force change in policy by the Government, and to make them listen to the united opinion of those that meet.

Such a Summit will need to be funded and we now ask for your assistance in making this happen. Such is the interest in the event that some sponsorship has already been promised by the BDTA.

We would ask all of you who feel we have been doing a decent job on your behalf, to make a voluntary donation of at least £20 to help fund this event and give assistance for further initiatives. A one day Seminar is planned for members later in the year on legal issues of the Contract. It is our promise that none of the money raised will pay the founder members but be used solely for the benefit of you, the members.

If you are, this Summit is designed to establish – based on your first hand evidence – whether a legal challenge to the new contracts is possible and whether the dental profession and its friends have any stomach for a fight - including the possibility of some form of direct action against the Government and the NHS.

We hope you will join us, share your experience with us and help us formulate a statement to Government and a recommendation to the profession to pursue a line of unprecedented industrial action.

The Government and the Department of Health are pursuing covert action against the dental profession. As well as dentists, thousands of others are losing out in the battle.

Infection control guidance from the UK Health Departments and vCJD

You will now have received information from your relevant Health
Department on the re-use of endodontic reamers and files, in which
they reiterated other infection control measures. I know that
members share our concern about the implications of this and I am
writing to let you know of the BDA's position and the action we are
taking, which were discussed at length at the Executive Board on
Wednesday.

We are appalled that once again the profession has suffered the hasty
imposition of a measure for which the evidence is slim. As the
Departments' advice explains, the risks associated with re-use of
intra-radicular instrumentation are theoretical. There have been no
known cases of transmission of vCJD via dental treatment. The
studies carried out are based on animal experiments using intense
exposure to very high concentrations of prion infected tissue. These
studies have produced what is described as a "plausible possibility"
of infection via the re-use of endodontic instruments. It is on this
basis that the Health Departments have issued the advice against re-
use and the Scottish Executive Health Department has restated and
strengthened its advice.

As dentists, however, we will take this advice very seriously and
must act upon it by ensuring that reamers and files are not re-used
until such time as it is reviewed. The BDA is, however, very
concerned about the justification for the decision, the method of
implementation and the consequential impacts of funding requirements
for dental care in all settings. We have made very clear that we
feel that the process is flawed and that the implications for patient
care and application in practice have not been thought through. We
called for urgent discussions with the Department of Health in
England and the first meeting has taken place

In parallel with this move, the Department of Health in England has
decided at the last minute that it cannot endorse the new version of
BDA Advice Sheet A12, Infection control in dentistry, which had been
due to be published in May. This is in spite of the fact that it has
been represented all along on the working group drafting the Advice
Sheet. The reasons for its decision are not clear, but we understand
that the Department will be issuing its own guidance later in the
year, as it already does for other areas of health care. We have
asked to be involved in the development of the guidance and shall not
be publishing an updated version of A12 prior to seeing it. For the
time being, we advise practitioners to continue to comply with the
current version (February 2003), which is available on the website
www.bda.org or from BDA Shop on 020 7563 4555.

We are taking urgent action on the following aspects:

Funding

We have made clear to the Department of Health in England our
concerns at the additional cost of implementing the advice on reamers
and files and Lester Ellman, Chair of the General Dental Practice
Committee, met with the Chief Dental Officer for England this week.
The Department has acknowledged the problem and has committed to
making arrangements to take account of the additional cost. We will
be discussing its proposals with the Department formally and will do
all we can to ensure that they are adequate to enable practitioners
to continue to provide the service. Further details will be sent to
you as soon as they are available.

In Scotland, additional payments for endodontic procedures to help
address decontamination costs and to provide for single-use
instruments were provided for in the Statements of Dental
Remuneration for both 2005 and 2006, following guidance issued by the
Scottish Executive Health Department (SEHD) in 2004 on the re-use of
endodontic instruments. The BDA in Scotland has been expressing its
concerns over many months about the implications for the delivery of
dental services of the proposals for stricter controls emanating from
various agencies in Scotland on the decontamination of dental
instruments. Representatives of the Scottish Dental Practice
Committee are due to meet with representatives of Health Protection
Scotland, SEHD and the new Chief Dental Officer for Scotland soon.

BDA Northern Ireland has received some initial funding proposals from
the DHSSPS; all dentists will be informed of the outcome and any
amendments to the Statement of Dental Remuneration.

Discussions with the Welsh Assembly Government cannot take place
until the elections are completed.

The evidence base for infection control guidelines

There is considerable debate among the profession, as well as between
experts themselves, on the evidence base for and the practicality for
dental practice of some of the expert recommendations on which the
various different infection control guidelines are based. This is
becoming increasingly complex as different and conflicting guidelines
are applied in different parts of the UK and even between primary
care organisations in England, for example. This situation
of `postcode cleanliness' causes confusion and makes practitioners'
lives impossible. We are therefore looking at how we can work with
experts to try to clarify best practice and will keep the profession
informed of progress. In the meantime, we repeat our advice to
follow A12 until further notice.

The Association takes this issue very seriously indeed and I hope
that this clarifies our position. Please be assured that we shall
work very hard to ensure that the standards to which dentists should
work are practical and cost-effective, while ensuring that care is
available and that patients and dental staff are safe. We shall keep
members up-to-date, via the BDA website www.bda.org.

Well it had to happen. The research on the possible risk of transmission of vCJD via endodontic files (which has been available for over 4 years according to some) has now gone mainstream. Our esteemd CDO has written to all of us to confim that it is "advisable" for endodontic files to be single use.

Now I have no problem with this, after all it reduces the risk of fracture. What I have a problem with is the FACT that the causative agent, the PRION, has been known about for over 20 years, and as I mentioned, the research that this advice is based on is hardly new. So why the F*CK were we all learning about it in the press first without actually being told by the DOH. Apparently Dental Directory have run out of files already!!!

It does also mean that rotary files are no an absolute no no for NHS RCT's. All for a theoretical risk of a pathogen some recognised experts don't even believe exists. I can tell you that there are many dentists who are not at all happy with this.

The British Dental Association calls on the Department of Health to
urgently address shortcomings in the new dental contract.

The inadequacies and flaws in the current method of monitoring the
dental contract were stressed at a meeting between the BDA and Chief
Dental Officer for England, Dr Barry Cockcroft. - What is the point of raising it with the CDO? Surely this should be raised directly with the minister responsible.

In a letter to Dr Cockcroft following last week's meeting, Lester
Ellman, Chair of the BDA's General Dental Practice Committee, writes:

"We are still firmly of the opinion that Units of Dental Activity
are fundamentally unfit for purpose.It is our view that the longer
these iniquitous and inappropriate units are in place, the more
damage will be done."

Dr Ellman is calling for the Department of Health to remove UDAs as
the only performance requirement stipulated in the contract
regulations. His letter urges Dr Cockcroft to explore alternative
performance measures through the evaluation of the completed
Personal Dental Services pilots and also by piloting different
contract monitoring methods. A more wide-ranging review of the
lessons learned from the PDS pilots is also being called for by the
BDA.

At the meeting, Dr Ellman reiterated the significant concerns raised
by dentists and patients reported at the special BDA conference to
mark the first anniversary of the new contract.

The BDA is pursuing with the Department the issue of business
continuity and the importance this has on continuity of care for
patients. The Department has been informed that dentists need to
have greater certainty about their future contract arrangements,
including contract value.

Concerns over the collection of patient charge revenue have also
been raised, and Dr Ellman's letter calls for the Department to
monitor the situation closely, to ensure money allocated for primary
dental services is not used to fund any shortfalls in patient charge
revenue.

"We are keeping the pressure on the Department of Health so that it
fully understands the problems with the new system and takes urgent
steps to tackle the serious issues we're raising," said Dr Ellman. With respect to Lester, if one million people marching on London cannot stop us going to war in Iraq, what chance does the BDA have of changing something which is just part of the slow gradual privatisation of UK healthcare?

Ends

Well, it's a new year, and we have yet to hear from the PCT. I assume they will be waiting on the BSA who I am sure are busy collating all the figures as they become available. They are still presently about a month behind processing all our electronic forms as far as we can tell.

On a different note, we saw signs of smoke on the horizon today. Apparently, doctors in Chesterfield who do minor surgical procedures must have equipment that is completely disposable (with written proof of adequate disposal) OR invest in a vacuum, autoclave with cycle printout facilities. Many are going down the disposable route as they are not being given any extra funding for this.

Much of the cross infection guidelines that are coming shortly are without adequate evidence base, and there is likely to be a lot of huhah about those naughty little prions the tabloids like to go on about occasionally. It will be interesting to see what the new A12 actually recommends

Last modified date: 16 April 2007 Gateway reference: 8136 The GDS
and PDS SFEs are amended with effect from 1 April 2007 to reflect
the adjustments to contract values and vocational training payments
for 2007/08.

The 2007/08 Adjustment will be factored into monthly payments by the
NHS BSA on a national basis. The PCT must not itself, therefore,
adjust the amounts that it has loaded into the NHS BSA's
computerised payment systems by these adjustments. Contract values
entered on the BSA system after 1 April 2007 should be entered at
April 2007 prices and will be subject to the further 0.229% uplift
with effect from 1 November 2007.

The 2007/08 GDS and PDS increases are:

Contract Value
2006-07 value uplifted by 2.765 % from 1 April and a further 0.229%
from 1 November 2007

Trainer Grant
£715.50 per month wef 1 April and £719.00 per month from 1 November
2007

VT Salary
£2,384.00 per month wef 1 April and £2,396.00 per month from 1
November 2007

Service Costs
£5,027.00 per month wef 1 April and £5,039.00 per month from 1
November 2007.

There are two further amendments to both SFEs for clarification.

The first clarifies the amount of maternity payments to make clear
that any Statutory Maternity Payments to which the dentist performer
is entitled is included in the calculation of her net pensionable
earnings and not paid in addition to those earnings.
The second is in relation to reimbursement of non-domestic rates to
make clear that the contractor must provide proof of payment for the
whole amount specified in the Demand Notice in all cases where the
rates were paid in monthly instalments.

There are several practices that are engaged in the Outreach scheme in Sheffield. These practices are investing significant sums in a project without even having anything definite on paper from the PCT. There is talk that the students will have to accumulate UDA's, which in my view is completely outrageous. it's bad enough the VT's have to meet targets............ but students as well.

If there is one thing that everyone seems to be ignoring when it comes to the NHS, it is this. North Sea Oil.

Steve, what the hell has North Sea Oil got to do with the NHS. Well, NSO is officially in decline. This means that tax revenue from oil is decreasing, and decreasing rapidly. This is also at a time when oil is having to be imported from other countries at ever increasing rates. This means less money for the treasury, at a time when exporters are starting to be hit by the developin recession in the US, as well as being hit by an increase in the price of raw materials.

Without money, the government cannot afford such a bloated beast like the NHS. Bits are being chopped from it left right and centre, and people honestly think NHS dentistry will survive in this environment. NSo helped bail out the "Sick man of Europe" in the 70's and 80's, but it's legacy has been wasted. I fear we are about to enter very interesting times indeed.

Eight steps to effective commissioning
16 April 2007

Government rhetoric about patient-centred commissioning is loud and
clear. But how will it work on the ground?

The Commissioning Framework for Health and Well-being identifies
eight key steps:

1. Putting people at the centre of commissioning

This involves giving people greater choice and control over services
and treatments, including self care. It also means access to good
information and advice to support choice. Mechanisms will be
developed to help the public get involved in shaping these services,
with advocacy for support groups who find it hard to express their
views.

2. Understanding the needs of populations and individuals

Joint strategic assessment by councils, PCTs and practice-based
commissioners will help them better understand the needs of
individuals. They will be able to use assessment and care planning
processes appropriately, and mitigate risks to the health and well-
being of individuals.

3. Sharing and using information more effectively

In order to make good decisions for individuals and groups, we need
to use and share information in an effective way. This includes
clarifying what can be shared under what circumstances, joining up
the IT systems of front-line practitioners, and encouraging
individuals and communities to be co-producers of information.

4. Assuring high-quality providers for all services

Commissioners should develop effective, strong partnerships with
providers and engage them in needs assessments. Procurement should be
transparent and fair. Commissioning will be focused on outcomes,
leading to more innovative provision, tailored to the needs of
individuals and supplied by a wider range of providers.

5. Recognising the interdependence between work, health and well-
being

Commissioners can facilitate collaborative approaches with businesses
to improve advice and support for individuals. Also, all providers of
NHS care will be incentivised to support and promote the health and
well-being of their employees.

6. Developing incentives for commissioning for health and well-being

Bringing together local partners using local area agreements will
help to promote health, well-being and independence. Contracts,
pooling budgets and using the flexibilities of direct payments and
practice-based commissioning are among the key mechanisms.

7. Making it happen - local accountability

The Department of Health and the Department for Communities and Local
Government will develop a single health and social care vision and
outcomes framework, including a set of outcomes metrics aligned with
the framework.

8. Making it happen - capability and leadership

The DoH and other national stakeholders will provide support to all
local commissioners to address their capability gaps. This support
will be tailored to different types of commissioners - PCTs, practice
based-commissioners and local authorities.

There is much talk about the new A12 which will shortly be released by the BDA.... the same BDA that got itself several million in debt and said Ribena was "tooth friendly". But I won't go down that route, because I promised not to have a go at the BDA :)

Anyway, It got me thinking. how much of what we are supposed to comply with is based on peer reviewed evidence. For example, I got my ultrasonic scaler back from the repair shop. Picked it up off the bracket table ready to place it gingerly in the patients mouth only to find the bloody thing wouldn't reach!!!! So I phone up the bloke that repaired it, who apologetically said that was the longest lead available to join the handpiece to the unit due to new regulations. Apparently its a no-no for handpiece cables to touch the floor because they might be a cross infection risk. Well they have achieved the ultimate in cross infection control by stopping me using my bloody equipment. Absolute idiots, just exactly which part of the cable goes in the patients mouth?

Unfortunately the PCT's will have little choice but to follow the regulations because they don't want to risk being sued. You, as a contractor of the PCT will therefor need to comply with these regulations or face having penalties imposed for breach of contract. You think it won't happen - have a look at what nursing homes have to go through. Have you seen the practice monitoring toolkit that PCT's are starting tom use. Do you have all your systems in place to make sure your staff comply with all the relevant regulations?

If you intend to stay in the NHS you better be prepared for this. The very least oyu should do is get BDA Good Practice, which is a recognised standard (see, I am nice to them occasionally.... their not all bad). In fact do Good Practice anyway, even if you are leaving for the private sector. You think private practices won't be faced with inspection at some stage in the future. Hoho, think again.

My new NHS charges poster came today, only 10 days too late. It's very interesting that it still mentions the patient info booklet which patients can request off their dentist............................ only of course no dentists I know have any because we were only originally sent 200....... only to be hastily toldwe couldn't give them out because it told patients they could have new dentures for £50.

Never believe what government tells you. Always assume they are trying to hide something, because usually they are. This is not conspiracy, it is just to do with the fact that most of the worlds governments have become so bloated they are rife with incompetance. The new contract is a fine example, as you will see below:

After a year of the new contract, NHS dentistry is perilously close to collapse, contrary to what Chief Dental Officer for England, Dr Barry Cockcroft would have you believe.

‘CHALLENGE’ – a pressure group dedicated to returning NHS dentistry to some semblance of sanity – has carried out a survey of dentists to find out their views and to reveal the truth.

The online survey was carried out between March 14th and March 24th 2007. Some 600 responses were received from approx. 2300 dentists working in 156 different PCT areas. Copies of the full report will be available shortly on request.

*Failing new dental contract needs to be overhauled/,/ says BDA*

The British Dental Association demands an urgent response by government
to the overwhelming consensus that its NHS dentistry reforms are failing.

In a letter to Chief Dental Officer of England Barry Cockcroft, Chair of
the BDA’s General Dental Practice Committee Lester Ellman cites the
weight of evidence against the new contract generated by last week's BDA
conference to mark the first anniversary of the reforms.

“The strength of this evidence means I must now write to you to urge you
to reconsider the current dental contract. Our concerns go beyond the
significant transitional difficulties experienced over the past year and
we can now demonstrate that the new system is in need of fundamental
reform,” writes Dr Ellman.

Dr Ellman, who is due to meet the CDO next week, identifies three key
demands:

1. Remove the Units of Dental Activity – the currency of the new
contract – as the only way of measuring performance.
2. Pay Primary Care Trusts directly the whole of their commissioning
budget, to avoid uncertainties in patient charge revenue collection.
3. Allow long term business stability by permitting dentists to
transfer their NHS contracts to new owners, thus maintaining the
goodwill value of practices

Dr Ellman also calls for the government to re-examine with the BDA the
findings from the Personal Dental Services pilots, an alternative model
for general dental practice trialled over a seven year period before the
introduction of the current system.

“Having conducted these pilots, the government has a responsibility to
evaluate them properly to see if there is a way of using this experience
to establish a system that will work in the long term interests of
patients, practitioners and tax-payers.”

Now admittedly, I've been a little bit hard on the BDA, perhaps undeservedly. There has been a lot of work done behind the scenes to improve the agency, and they can only do so much. However, the PERCEPTION is that one man has done more to fight this cockup than the whole of the BDA and DPA combined. Eddie Crouch and Challenge have done a lot to highlight the dodgy legal ground this contract is on.

I however still do feel that they are all missing the point somewhat. The point, in my mind, is that the NHS is dying, the government cannot afford it, and we should all be getting out now, or preparing to get out now.

The BDA does do a lot of good work, especially with the Sick Dentists Scheme and the Benevolant fund, BUT, they have a lot to do to regain the trust of the profession in my view.

Copy to: PCT Directors of Public Health
PCT Consultants in Dental Public Health
For information: SHA Chief Executives
Regional Directors of Public Health

This is to advise you that the Department of Health and Strategic
Health Authorities have agreed that a survey of the dental health of
5 year old children should be undertaken in 2007/08 as part of the
rolling programme of national NHS dental health surveys.
There is a requirement for PCTs to provide or secure the provision
of dental health surveys under Statutory Instrument 2006 no.185 "The
functions of Primary Care Trusts (Dental Public Health) (England)
Regulations 2006".

Normally, staff from the PCT salaried primary care dental services
will be responsible for undertaking the surveys and PCTs will have
an examiner(s) calibrated for this purpose. A national training and
calibration exercise will be arranged later in the year and I hope
that you will be able to support your staff attending this as
appropriate.

NHS dental health surveys are an important source of local health
needs information for PCTs in supporting the local commissioning of
dental services. This survey will also be of particular importance
to SHAs who host fluoridation schemes or who are considering
consultation on new fluoridation schemes as a contributing part to
the four-year health monitoring which they will have to undertake,
the regulatory requirements for which are laid out in the 2003 Water
Act. I would therefore strongly recommend that PCTs continue to
commission and support these surveys.
Yours sincerely,

..........................funny, but the bloke in the picture looks a bit like Tony Blair. Is he having that lower incisor cleaned do you think :)

The dental contract has been cancelled and Rosie has promised every dentist in the country the chance to clean Tony Blairs lower incisor.

Of course this is an April Fool, but what isn't is the ludicrous hunt on the internet to find the Application for personal Payment Under Statement of Financial Entitlements. I mean, just the very name wants you to grab someone by the collar and shout "WHAT IS WRONG WITH YOU?"

I see the rumour mill roars on. Apparently in Derbyshire, the PCT are negotiating with a company called Genesis to purchase 50 dental practices across the county for the provision of NHS care. Of course its just a rumour, as is the fact that they have already bought 3 practices. Just in case anyone from Genesis is reading, you can buy my practice for £1 million ;)

Looks like you cannot even get referred to hospital anymore without the bizzy bodies sticking their beaks in!

_pain_patients_must_go_to_jury_panel.php

or

http://shrunklink.com?umw

"FIRST it was the doctors - now it is the dentists.

In the latest attempt to clear their massive debts, cash-strapped
health bosses have banned dentists across York and North Yorkshire
from directly referring patients to hospital for key treatments. They
will have to submit patients' cases to a panel at the primary care
trust (PCT) for approval - and only those deemed "exceptional" will be
accepted."

As we near the fateful end of year date, I hope every NHS dentist in the country has their escape plan ready. The vast majority of you, in my opinion, will not survive in the NHS, not if you want to keep your sanity. You think the treadmill was bad in oGDS, try meeting targets with an ever decreasing UDA value. Try keeping an ever cash strapped PCT happy.

And on another note, below is a DoH press release, published this morning (my unbiased (!) comments in green.

At the end of 2006, over 28.1 million patients had seen a dentist in the previous 24 months in England - 20.3 million patients seen were adults and 7.8 million were children. This breakdown by adults and children is available for the first time from The Information Centre for health and social care (The IC)

These figures equate to 55.7 per cent of the population - 51.5 per
cent of adults and 70.5 per cent of children.

The statistics are the third quarterly release of data on NHS activity
and workforce since the launch of the new commissioning and
contractual arrangements for NHS dental services on 1 April 2006.

There were 9.3 million reported Courses of Treatment (CoTs) processed
in Q3 of 2006/7 which is an increase of 391 thousand since Q2. The
highest number of courses were Band 1 (which include routine
examinations, scaling and diagnostic procedures only) which is
consistent with previous quarters.

Courses including treatments which require laboratory work, such as
crowns, dentures and bridges (Band 3), which take longer to complete,
have increased from 3.3 per cent in Q1 to 4.3 per cent in Q2 and 4.5
per cent in Q3.

The total number of dentists on open NHS contracts as at 31 December
2006 is 20,887 in England. This shows an increase of 602 dentists
since 30 September 2006. However, the NHS Business Services Authority
(BSA) estimate that most of the increase is attributable to improved
timeliness of data and a slight change in the recording of contract
details which took effect from 1 October 2006. There is an NHS dentist
for every 2,414 people [And yet less than half the population saw an NHS dentist in 2006 which doesn't exactly sound like much of an improvement to me - and one wonders jsut how many of these dentists are either oversees imports or dentists with Kids only contracts....both categories highly likely to do an Elvis and leave the building in the near future].

Professor Denise Lievesley, Chief Executive, The IC, comments: “These
figures show the new system is settling down and it is good to see
activity numbers increasing [Of course activity numbers are increasing, people are sheep dipping to get their UDA's in]. As this series of quarterly statistics builds, it will provide increasingly valuable information for
providers and commissioners alike in monitoring performance and
identifying areas for further improvement.”

Well there you go, that's all right then isn't it. let's all put on a happy face and dance an Irish Jig. My life almost feels complete :p

Dentists on the whole are a funny bunch. Like most of the British population we rolled over and exposed our portly bellies to the powers that be when the new contract was introduced. They whinged that the BDA "did nothing", when in all fairness past history shows that trying to unify dentists into a collective mind is like trying to stick wheels to a tomato - time consuming and completely pointless.

There are some exception of course. Eddie from Birmingham who co-founded Challenge is one. And this gentleman is another:

Apparently GMTV will be doing something on the new contract on
Monday in the run up to 1 year anniversary.
I was asked by BDA media if I would do a live interview from my
practice not as a BDA spokesperson but as a normal GDP.

This would involve me getting to work at 5am in order to help them
set up. I agreed and asked GMTV exactly what would be happening and
was told live link to practice and interview with Peter Ward would
follow.

I asked if anybody from DoH would be there specifically CDO. I
outlined where I wanted to come from in the line that I would take
is that we are the only practice in Rochdale borough taking on new
NHS patients, my staff find it v stressful from the demands of the
new pt's, the contract has not improved access to NHS dentistry,
improved the pt experience or improved the working lives of dentists
and their staff. GMTV said that they would get back to me.

At about 3pm I received a phone call from GMTV saying that there
was "a problem" in that because last year I had made "a gesture" on
GMTV the CDO was not prepared to come on if I was on. They asked if
there was anybody else who could come to the practice or anybody
else that I could suggest to which I replied "no other idiot is
going to get up at 4 am to get to work for you and if you want
somebody else go and speak to the BDA media department" and promptly
put the phone down.

I immediately sent CDO a text which read "I am very sorry that you
do not feel able to put events of one year ago behind you. I
apologised to you for what I did. I hoped that things could move on
but clearly you do not wish for that to be so. Tariq"

V weird but after this all that flashed through my mind all
afternoon was the vivid memory as a child of seeing TV pictures
Anwar Sadat the former Egyptian president getting off a plane in
Israel in an historic first for an Arab leader and shaking the hand
of (amongst others) Golda Meir a woman he had once called an "evil
witch". She was gracious enough to put things that were in the past
firmly in the past and move on.

Look at N Ireland and the former Yugoslavia where people who hated
each other were prepared to sit round a table and talk about their
differences and try and resolve them. These are important things
where people died and countries bled and humanity suffered.
This is just NHS dentistry for heaven's sake!

I am very angry indeed that CDO is not prepared to move on. Even
Rosie Winterton joked about it with me when I met her at the Labour
party conference in October when I did a fringe meeting on behalf of
the BDA with Lester.

As a nation we have been lied to by our politicians misled by spin
doctors manipulated by the media and yet all these people are in
their jobs and treated with respect as though nothing was wrong. If
every politician who made a mistake was treated the way that I have
been by CDO then nobody would speak to anybody in the House of
Commons. I am a human being and we all make mistakes. I am not proud
of what I did and I did immediately apologise to CDO.

I am however proud that I out argued him and beat him hands down
verbally. Another news organisation told me that they were told by
DoH that CDO had got "a roasting" from me on GMTV and that the
minister had not been happy.

I feel very angry and yet at the same time I feel pity for him. An
important quality of great leadership is to be magnanimous -
defined from dictionary.com as "generous in forgiving an insult or
injury; free from petty resentfulness or vindictiveness e.g.to be
magnanimous toward one's enemies". Look at Nelson Mandela as an
example of this.

Trust is a strange thing; once lost it is almost impossible to regain. Such
is the position with the DoH whose statements are regarded by many with a jaundiced eye or should that be ear? Whichever that may be the net effect is the same the credibility of bland statements that all is well in the state of the NHS are treated with the skepticism they deserve.

The Doctors and Dentists Pay Review Body (DDRB) recommended an award of 3%
on gross contract value designed to yield 2% on net pay. But the Department of Health (DoH) has advocated a pay award of just 1.5% on gross, hardly designed to encourage any practitioner who is thinking of leaving the NHS to stay in it. The DoH asserted that 1.5% on gross contract value would bring a net increase of 4%. But DoH has accepted the DDRB's recommendation of 3% on gross contract value which the DoH has split into staged payments: 2.765% from 1 April and the balance,
0.235% in November. (What will you spend you November increase on? An ice
cream cone? Single, of course!)

This is not the case in Scotland where the whole award will be made on 1
April. The rationale behind this staging escapes me. But, in accepting the DDRB's
recommendation they have tacitly acknowledged that practice expenses are indeed much higher than they postulated because the 3% on gross contract value was designed to give 2% net. This shows that the DDRB accepted our logically supported arguments that practice expenses are considerably higher than the DoH has tried to persuade them to believe by presenting flawed logic to back up their statements.
I remain disappointed by the DDRB's refusal to award a practice allowance, like there is in Scotland, which would reward the practice owners for the additional
capital, risk and administration which they put into the provision of dentistry and upon which the NHS has depended since 1948. However, be aware that if dental inflation proves to be higher than the award this will mean that the NHS part of your practice will, effectively, suffer a pay cut.

The new contract has not made dentists' lives any easier, it has merely
substituted one treadmill with a more pernicious treadmill which has the menace of reduced annual contract values and claw-back hanging like the sword of Damocles over the practitioners heads. DoH has never addressed the problems of patients' oral health gain and prevention; this has never been seriously discussed. It has not, apparently, promoted research into ways of measuring this so that it can be measured and incorporated into NHS working and rewarded accordingly. Until this is done prevention will be paid lip service but will never be effective as it takes a lot of time and requires constant reinforcing; this is not consistent with achieving UDA targets. The new contract, in any of its forms, has not improved access to NHS care for most patients nor has it tried to secure the services of those practitioners who are the backbone of the NHS. Removing the discredited UDA targets from the system will free up practitioners to concentrate on patient care without the distracting threat of being short of target with the unpleasant consequences. In response to my questions in my last letter, you have made it clear what you think about UDA's. The BDA will be pushing the DoH to consider a broader and more flexible range of measures of output and quality of care that are workable, instead of relying only on the rigid and reductive UDA target-driven system we have now.

There also needs to be some firm direction from the DoH about the unallocated UDA's
and the funds attached to them. This money is being withheld to support the PCTs'
probable PCR shortfall. This does nothing for frontline patient care and simply reduces the already difficult access to NHS treatment. There needs to be an
injection of funding to the PCTs to alleviate their burdens as they are caught between a rock and a hard place: they have no influence on the amount of PCR collected yet they are responsible for making up any shortfall: this must be unfair. Much of the flak related to patient dissatisfaction about poor or non-existent access lands on their staff who have no way to ease the patients' difficulties despite being sympathetic to their plight. We will be calling upon the DoH to change the current PCR arrangement so that PCTs and local health boards either receive their dental budgets in full rather than net of their projected PCR or have access to a central fund which supports any revenue shortfall.

There needs to be a proper DoH policy on how UDA shortfalls are to be
treated in this inaugural year and that needs to the same everywhere in the country. This uniform treatment is the responsibility of the DoH who must ensure that the guidance they give does not leave these important decisions to be made at the whim of an individual PCT.

The Implementation and Review Group meets again later this month and though
we cannot expect that it will achieve vast changes I hope we will see that it
is definitely beginning to make serious attempts to address some of the very contentious issues which beset this flawed contract. We have all been very patient appreciating the that there is a dearth of data but we are almost one year into this new arrangement and conclusions must be able to be drawn from the large amount of data which is available. Surely action must immediately follow?

We are all human and because of that it is accepted that we can all make
errors. How many times have we got things wrong in a patient's treatment? Naturally, we did not set out to get things wrong; no-one sets out to do bad dentistry or cause
problems for ourselves or the patients but, we are forced to make decisions on aspects of the care of an individual which occasionally turn out, with hindsight, to be ill judged and wrong. Those of us with experience admit the error and set about rectifying the mistake. Those of us with more experience will try to pre-warn the patient of the possible hazard and then, when it does arise, set about rectifying the problem. The result is the same. We accept that our judgment is imperfect; we admit the action we took has failed to produce the result we hoped for and we effect plans to remedy the situation as swiftly as possible. Can it be so hard for the DoH to admit that this contract, entered into by them with such great hopes, is not in any way achieving what it was, supposedly, intended to achieve? It is apparent to those who care to look and not to close their eyes that this imposed contract is failing in significant ways. It is not improving the lives of the dentists or access for
patients or the oral health of the nation. It has fallen short on every count.

The BDA has been busy collecting its own evidence on the impact of the new
contract and I'd like to thank all of you have been involved in this. We're now
collating the information from our survey work and the initial findings look very
powerful. I can assure you we will be using these in our discussions with the DoH and
generating maximum publicity and leverage around them. The focal point will be a
conference at BDA headquarters in London on 28 March at which the research will be made public. This event, to be attended by about 100 people from across the sector,
media, politicians and representatives from other influential healthcare organisations, will be used to raise further awareness about dentists' views on the new contract. At the conference, Citizens Advice will also launch their own research on the first year of the new contract, assessing the impact the new system is having on patients. As we approach the 1 April anniversary, our media and research teams continue to sustain the momentum and the coverage of our difficulties remains high on the news agenda. My recent media work has included a BBC radio interview on dental tourism and an interview with the Daily Mirror on our dissatisfaction with the new contract, prompted by the media frenzy surrounding Gordon Brown's private dental treatment.
I will keep you posted of these developments around the 1 April anniversary and in
particular the findings of the BDA research.

In my last letter I asked you to vote on three specific items which I believe will help to rectify some of the present problems; at least until a more long term reconstruction of the contract can be designed.
These are :

-Remove UDA's as targets
-Promote Quality of Care
-Remove PCTs' liability for PCR shortfall

A huge number of votes came in and it will be no surprise that they were all
in favour. I am extremely grateful to those who took the time and trouble to register
their vote and even more grateful for the support which the votes demonstrated. We shall, again, be raising the arguments which you have shown to be pertinent to most GDP's and also to our salaried colleagues and we will emphasise your thoughts to the DoH. If any of you missed the opportunity to register your opinion please take
this opportunity to do so now by sending your vote by email to

-I am in favour of the changes listed :
-Remove UDA's as targets
-Promote Quality of Care
-Remove PCTs' liability for PCR shortfall

If you have voted previously please don't vote again as it distorts our
figures.

Once again this year the VDP Careers Day, jointly organised by the Eastman
Dental Institute and BDA, was a great success. The VDPs braved the snowy conditions to get to London for this important event. They were addressed by many speakers including the CDO, me, and others including Amarjit Gill from BDA's Executive Board. The opening session was hosted by Graham Brown, Chair of BDA's Education Committee. The VDPS were persistent in their pursuit of the CDO for answers to their questions about their experience of UDAs. After all, their future and that of the profession, is in the balance and they wished to know to which of the many paths being spoken about that day, and not just General Practice, they should pay particular attention. The parallel sessions were all very well attended which demonstrates that our young practitioners are not blinkered to the many possibilities.

Another in the very successful series of these seminars was held in the BDA
in January, Those who attended heard a variety of speakers, all experts in their
subject, addressing the issues for those who may be considering moving to the private sector. The speakers cannot make that momentous decision but they can and did point out the advantages and the disadvantages together with the pitfalls and problems. All of which demand much thought and careful planning.

It will be here soon enough. There needs to be a lot of thought given to the
possible effects that the removal of any ring fencing may bring. Will the dental
budget get depleted in favour of other things? If that does happen, and it seems
likely, how will your practice respond? Will you be able to manage to survive? I offer these questions, not because I have all the answers for every practice but, because I firmly believe that this is the time to begin to seriously consider and plan what you will do, if you have not yetbegun the process.
Best Wishes,

Year end reporting guidance has been issued for NHS dentists by our benevolent leaders.

It only takes a minute or two, although I personally found the questions a bit restrictive.

I wonder how many NHS dentists (the ones who have not yet met their glorious quota) have felt inclined to go on holiday this month. Not many i bet................ except for me :) Your health and your mental well being are far more important than a government set target, especially one based on an untested system.

*Dental contract ‘failing both patients and dentists’*

Figures published today by the Department of Health provide further
evidence that the Government’s dental reforms are failing both patients
and dentists, according to the BDA. The Dental contracts statistics show
that more than 1.5 million units of dental activity (UDAs) had yet to be
provided 10 months after the new contract was introduced. UDAs are the
currency used by the new contract to measure the amount of treatment
being provided. A check-up is worth one UDA. The statistics, which
illustrate the situation at 31 January, also show that the amount of
treatment the Government believes had been commissioned has fallen since
November.

The figures also reveal that the contracts initially signed in dispute
are being resolved at a slower rate than previously. Just 158 contracts
that were originally signed in dispute were resolved between the end of
November and the end of January. At this rate of resolution it will be
18 months after the launch of the reforms before the 710 contracts that
remain in dispute are addressed.

Responding to the figures, BDA Chief Executive Peter Ward said:

“These figures are bad news for patients and bad news for dentists. They
highlight problems with both providing care to patients and resolving
the significant difficulties facing practitioners. They also underline
the uncertainty facing NHS dental care.

“They are a woeful indictment of the Government’s reforms. Sadly, they
come as no surprise. We know, from our own research and what our members
are telling us, that many practitioners are experiencing significant
problems with this target-driven contract.”

This clearly shows why your future exists outside the NHS. Have you phoned practice plan yet :)

No matter how hard the powers that be spin things, the truth still leaks out occasionally.

"NHS dentistry faces a £120 million shortfall because the Health
Department wrongly estimated how many patients would contribute to the
cost of their treatment, the Tories claimed yesterday"......

http://www.timesonline.co.uk/tol/news/uk/health/article1490015.ece

Of course none of this really matters, because the decision about NHS dentistry has been made by high people in low places. We as dentists have to remember that the PCT's have been shafted financially. We have to appreciate that fact when we deal with them.

A word of warning to check your schedules thoroughly.
We have had a schedule today with a few disallowed claims. We
got the cards out to check why and the first claim disallowed as
a "continuation" was for a patient who attended for the first time and
had an examination with NAD -excellent OH marked on card. Paid £15.50
Had only one form sent in and one point claimed!!!!

They appear to be making things up as they go along. What a complete and utter surprise.

There is a 3 surgery practice not far away from me that is, to coin a phrase, "going mental". Because they are short on their UDA's, they are cramming patients in left right and centre, 50 a day per surgery. This is not health care, this is a treadmill pure and simple. If I ever get to the point where I feel even tempted to sheep dip patients I will walk away from the NHS instantly rather than doing my slow conversion.

Thanks again for all the help you have been with information on what is really happening in the dental world!

I have been speaking to Andrew Lansley [shadow Secretary of State for Health] who like me is passionate about Public Health in general, and he asked if 2020health could ask our contacts whether you would be able to do a straw poll of your colleagues so we can get some up to date numbers on the situation. We will put the numbers up on the website with a press release in the second / third week of March so they will be there for all interested parties to see. Public Health is rising up the agenda and it would be really good to get dentistry firmly at the centre.

If you could very kindly spare the time, could you ask up to 10 of your colleagues:

1. Have they run out of UDA's? If no:

E.g. If 20,000 UDA’s assigned and they will have done 16,000 by end Jan, they will have done 80%

By the way, are any of you involved in the BDA or DPA events at the end of March?

thank you once again for all your help
Julia

Julia Manning BSc (Hons) MCOptom WCDC
Director
www.2020health.org
Julia@2020health.org
07973312358

Oh, this open letter from Rosie really gave me a healthy chuckle. My comments are in green:

Sir: Dentists are not turning away patients because of shortfalls in
income from patient charges (article, 1 February). Dentists have
agreements with their local Primary Care Trust about how much work
they carry out on behalf of the NHS over the year (based on calculations which were flawed, made up and based on an untested system). These agreements
are not affected by levels of patient charge income (although PCT's are and have been left with unexpected and unnecessary debts).

The new contracts were designed to give dentists exactly what they
asked for: more time with patients (NO, the new contract was designed to cap the dental budget and INVITE dentists to drift towards the private sector even faster). A small minority of dentists say
that they are going to deliver their agreed services before the end of
the year. This suggests they may be speeding through their work rather
than spending time to offer patients a better, more preventative
service (or perhaps it represents a system that has been untried and untested). The local NHS is working with these dentists to help improve
the service they provide (and how is a PCT, with no experience in delivering Primary dental care, to do this when they also have no experience in dealing with UDA's because they are ...................oh, tried and untested).

NHS dentistry is expanding, with PCT's now commissioning more services
than under the old contract (REALLY, and what exactly is the weather like on Mars today?).

Let's see if we can figure out how to claim UDA's. The following is the basis of email communication with the BSA.

Dear Mr. Hudson,
In response to your queries, please find answers following each of your questions below:-

If we do a filling and patient pays Band 2 and then comes back 1 month later with another tooth fractured that needs a crown, what does the patient pay?
Full charge under Band 3

If patient has an urgent problem, but waits for their exam appointment to have the issue corrected, what does the patient pay and how many UDA's do we claim e.g. a denture ease
If they wait to start a new course of treatment, then the appropriate charge for the treatment total under that course applies inclusive of the urgent problem. - No extra UDA's above those that apply for the treatment course Band.

I am practitioner A. I do an exam and refer the patient to practitioner B for an extraction, how much does patient pay me, and how much does he pay practitioner B...... and how many UDA's do i claim?
This depends - does the 2nd practitioner have a specialist surgical referral contract? Is the second practitioner within the same practice ? Different conditions apply to referrals for sedation, or under "Advanced Mandatory Services e.g. Perio/Oral Surgery/Endo".

Where a patient has commenced a course of treatment with one provider but is referred to an alternative provider, only one charge for the course if treatment calculated under Reg 4 may be made and recovered. Dentist A charges the patient for the whole course of treatment and claims the UDA's for that treatment. Dentist B also claims UDA's for the whole course of treatment but does not charge the patient. They cross the box in part 6 which says treatment on referral so that they do not have the money for the patient charges deducted as well.

However, the requirements when referring patients is quite involved.
Generally if a patient is being referred to a hospital then the dentist would only claim UDA's for the service provided before the referral.

Patient comes for exam and needs a free item (e.g. script) - how many UDA's do i claim?
Free items are listed in Part 7 of the FP17 form and ONLY these are exempt from a charge. The UDA's vary between 0.75 and 1.2 for these items and are automatically allocated when a free treatment option is ticked. If the patient has attended for an exam under Band 1, then a prescription would be included under Band 1 anyway and no extra UDA's would apply.

I really do hope that 2007 proves to be a better year for dentistry than 2006 was. Writers on the subject of Change Management often say that "Change hurts" and more profoundly that "Big change hurts a lot!" Having had nearly sixty years of working with a largely predictable, if chronically under-funded, National Health Service, general dental practitioners must now realise that the government means business. A long time ago, Sir Kenneth Bloomfield declared that "No change is not an option". But little did we know that the fruit of his review of NHS general practice dentistry would take fifteen years to ripen into something called nGDS.

For the government, the new contract may be seen as a master stroke. But the rest of us realise that this was nothing to do with patients, it was nothing to do with health and it most certainly was nothing to do with dentists. The new contract is about cost control and driving down market rates – it is a contract written by a finance professional, not by someone with an interest in health care. It has fundamentally failed in the stated intention of taking dentists off the treadmill and of providing an environment that encourages preventative dentistry. Having gone to the trouble of commissioning a range of possible options under PDS pilots it is a great shame and a missed opportunity that the government then went on to disregard them all and introduce something completely different. Given that many of the pilots seemed to be delivering on the stated aims, one has to wonder why?

Central government has also removed itself from the nasty business of accountability. It charged PCT's and LHBs with the responsibility of commissioning. They could do this any way they liked - as long as their contracts contained the compulsory 150 pages from the regulations. They were given a budget to do it (minus the expected patient contributions!) which supposedly reflected previous levels of consumption. Just to make life interesting for the people who had never had to do this before, they were, at the same time, told that they also were to be re-organised. I just wish I could believe that this was a conspiracy it would be something worthy of a James Bond villain. Regrettably, I think not. I think the timing of the changes was purely shambolic coincidence.

But the consequences have been dire: the precipitous introduction of the new contract; the misunderstandings; the mis-interpretations; ill-judged departures from the NHS; ill-judged remaining within the NHS; incomplete rules and un-thought-out consequences. So where does this leave us as we anticipate the contract's first anniversary? Well as dentists do, many are getting on with it. They are getting on with it in the belief that it will all be sorted out around them. Others are struggling, have struggled. In some areas there have been terrible fights over interpretation, over inaccurate values, over onerous terms and conditions. Progressively some of the difficulties are resolved – but the resolution is incomplete, and new themes continue to emerge. The fragmentation of commissioning makes it very difficult to gain any sense of consistency of approach. Local commissioning means doing it differently in different places it means that local managers are accountable for both a service and a budget. It means that the pressure is only likely to increase. Much of this leader has focused on the "other side" and that is quite deliberate. If dentists are to survive and prosper and have that happy new year that I wished, we need to take control of our future. To do so, we first need to understand what our options are. Signally, we must understand that the NHS has changed fundamentally and for ever.

The BDA has fought, and will continue to fight, over the legality of the new contract. Most importantly we will fight on behalf of individual members who have been wronged by inappropriate behaviour or unfair treatment. But whatever the outcomes, we must all realise that the future is going to be very different to the past. Dentists in general practice can no longer rely on a consistent, predictable right to practice what they want where they want. They must understand their own expectations and what their practices cost to run. They must get a clear understanding of what is on offer locally, both from the NHS commissioners and from the private market. In assessing these things they must also understand what they are committing to (there is a lot in those compulsory 150 pages that is yet to be brought to bear). When they have done all of this they need to decide on the best route for their practices and their careers. The long relationship of dependency on the NHS is officially over. Dentists must now take control of their businesses in a business- like way. By taking some time out to make their practices viable and sustainable, they will then be able to get back to doing what they do best caring for patients.

More than 9 months into the new contract and, despite the hype from
the DoH of how well it is doing, it is plainly not working. It is
quite clear that it is not helping dentists nor is it helping patients.

Whilst my role is unequivocally to look after the interests of my
colleagues we must not forget that our raison d'etre is the well being
of our patients.

Dentists are forced to focus on UDA targets and this distracts them to
some extent from the healthcare provision. They are either frightened
that they will not achieve their UDA target and leave themselves open
to some unknown disciplinary action by the PCT or they have run out of
UDA's and are in a dilemma as to how to deal with their patients who
need treatment. Do they shut up shop between now and April except for
true emergencies or do they treat the patients for no additional
funds? What a difficult position for an ethical, conscientious,
healthcare profession to find itself in.

The BSA seems incapable of consistently producing accurate up to date
information about UDA's and money which leaves the practice in a
position of possible contention with the PCT who may believe that the
performance is less than the true position and may wish to claw-back
funds. This is compounded by the DoH changing its mind part way
through about how some things are treated; such as any excess UDA's
which might be generated by a VDP which was originally to be credited
to the practice but will not be. Any excess Patient Charge Revenue
(PCR) thus generated will simply swell the coffers of the PCT. Had
this been stated at the outset it would have been bad enough but to
have it changed part way through the year is unjust and demonstrates
how poorly thought through the system is. I can understand any GDP who
no longer wishes to apply to be a trainer.

What about our patients? How do they fare in this chaos? We are
trained at high cost to provide the best treatment which meets their
needs but this new contract has drivers which push us away from this
ideal. There is a positive discouragement from undertaking extensive
treatment. Instead the pressure is for a minimalist approach: `to
simplify courses of treatment'. This may suit the needs and desires of
some patients but extraction instead of complicated treatment may well
not be in their best long term interests. I have no real fears for
those who can afford to purchase whatever version of modern dentistry
they wish. But I have great concern for the `have-nots' who cannot
make such purchases. We all have a right in this developed, welfare
society to decent modern healthcare and though dental disease may
rarely prove fatal this does not diminish its importance in health. It
is a damning indictment of the system which makes dentists regard high
needs patients as less desirable because the amount of work they will
need will disrupt the production of UDAs and may lead to them failing
to reach their targets. Had the DoH listened to us they would have
known that this
was the likely outcome of a system which has no positive incentives to
take on those in most need.
What we are seeing is the beginnings of the breakdown of NHS dentistry
in all aspects except for the very basics. This is a return to the
dentistry of the 1960s when little other than basic dentistry was
available. Already there are commissioning staff at PCTs who see the
funding of a `core' service as the only way they can balance their
books and acquire some much needed funds by depleting the dental
budget in 2009.
We cannot stand idly by and allow the destruction of true NHS dentistry.

With a capped budget which is reducing in real terms unless we get a
very substantial increase from the DDRB we will experience a pay cut!
It is interesting to note that the DoH recommended an increase of just
1.5%. How many of us can increase our staff pay by just 1.5% and
retain them? Energy costs have increased by 38% this financial year
but the DoH states that 1.5% is a generous reward.

Some PCTs are known to be holding back unallocated UDAs and the funds
which are associated with them so that they may use those funds to
offset any PCR shortfall for which they will be liable. The CDO states
that this is OK as the money is going to `dentistry'. But this will
not improve patient access nor allow practices who might wish to grow
to do so. This is surely just the PCTs covering up for the DoH's
miscalculations on what PCR should be. Had the DoH listened to us they
would have known it was impossible to model PCR on the old data. Once
the parameters had changed the old information was completely invalid.
Once again it is we and our patients who will suffer the consequences
of their incompetence.

Another aspect of this syndrome is that when dentists move from the
NHS into the private sector they take with them the adults who pay for
their treatment leaving a greater proportion of those who do not pay
behind to be treated by the NHS. Hence it is hardly rocket science to
work out that PCR will be less than it was previously.

We must also look at the effects of the changes on our salaried
colleagues who are also subject to UDA targets. This has to be
ludicrous as their role is to look after those who are unsuitable for
treatment in general practice. This often requires that lots of time
is spent acclimatising the individual and to gain their trust so that
any procedures can be carried out. Obviously, the amount of time which
will need to be spent will vary with each individual. How can such a
variable quantum be subject to UDA targets? What will happen if the
salaried colleague falls short of the target? Will there be claw back
or will he be instructed to treat only the simpler cases so that there
will be no excessive time spent on the difficult patients?
Is this any way to run a Health Service?

All in all, the whole seems to be a sorry mess which is out of
control. If the DoH believed it could constrain the PCTs once it
granted them freedom to behave more or less as they want they are as
misguided as Pandora when the contents of her box were released. Once
the cork is out of the bottle there is no hope of containing the contents.

After careful analysis, and here my colleague Janet Clarke, chair of
CCCPHD which looks after our salaried colleagues, joins with me. We
accept the need for dentists' activity to be monitored because some of
the money being claimed is public money. But we feel that relating
UDAs as the target by which all judgements are made and against which
financial sanctions may be applied is iniquitous and merely produces
resentment in practitioners and is unhelpful to patients: especially
given the fact that there is no accurate, reliable data being produced
by the BSA. And the major software suppliers claim that their data is
not robust due to misinformation from the BSA, who in turn blame the
DoH. The allocation of culpability is not relevant to the fact that
the confusion is clearly causing distress to dentists and patients alike.

1. Remove UDAs as targets
2. Promote Quality of Care
3. Remove PCTs' liability for PCR shortfall.

We will press for these changes if you, our colleagues in Primary
Care, indicate that this is what you wish us to do.

Please fill in the short form below to indicate your wishes and email
it to the address below. It is imperative that we get as many
indications of support as possible so please cascade this down to as
many colleagues as possible.

.................................
I am in favour of GDPC and CCCPHD pressing for:
Removal of UDAs as targets
Promotion of Quality of Care
Removal of PCTs' liability for PCR shortfall

Name.....................
Practice/Clinic Post Code.............
GDC No...................

To send this by email: outline the form by left clicking the mouse and
running the cursor over the text then right clicking to get the menu.
Select `copy' and then position the cursor on the text portion of a
blank email and right click which brings up the option to `paste'.
Click this and the form should transfer to the email body.
Fill in the details as required and send to the above email address.
We await your endorsement

Primary care trusts (PCTs) are facing massive budget shortfalls and have begun cutting back on services as money for dentistry “runs out” – just 10 months after the government initiated extensive reform in the sector.

According to a report by the BBC and the Daily Mail, the government underestimated how much money would be raised by dental fees from patients, and health chiefs in Yorkshire, London, Surrey, East Anglia and the Midlands have all reported problems.

The British Dental Association said some dentists had already begun to turn children and other patients away, and that the government had “got his sums wrong”.

"The government made an arbitrary assessment of what levels of patient fees there would be – but left accountability for it with primary care trusts," said Peter Ward, chief executive of the British Dental Association.

“PCTs know they will be beaten up if they are in the red at the end of the financial year so in order to balance the books they are withdrawing money that was there for patient care."

According to the reports, the Department of Health (DH) said that it calculated that trusts should be making £630m from dentistry fees, making up a quarter of their entire dentistry budget. A spokesperson has since said it will not know the final position until June, and that it “cannot predict with any confidence what the total charges collected over the year will be”.

According to the Daily Mail, in October the DH sent out a memo to PCTs acknowledging that some areas were reporting "lower than expected" revenue from patient charges. The memo said some dentists were giving a "greater priority to exempt patients" and urged PCTs to encourage practices to change their procedures.

Liberal Democrat health spokesperson, Sandra Gidley, said: “With many NHS trusts deep in deficit, they simply cannot afford to bail dentists out of this latest government-created problem. Their hands are tied.

“Rushed implementation of a system that was not tried and tested has led to the government underestimating the number of exempt patients. The impact will be felt by all patients.”

There are reports that the Pearl download software provided by Baker Heath is giving faulty UDA calculations. There is a definite discrepancy between the information inputed for download, the computer UDA totals and the BSA UDA totals (but then the BSA are reported to be about 2 months behind). I will keep you informed.

Looks like the PCT's are getting even more guidance on how to get dentists to maximise PCR's. I'm sorry, but that isn't in my contract so it's the PCT's problem. The last time I checked I didn't work for the Inland Revenue.

More evidence that you will be unable to seel your NHS practice without the PCT's blessing. Make a sentance out of these two words: PRIVATE, GO.

For those of you in the NHS, I recomend the following course run by the founders of CHALLENGE:

TITLE: Mr / Mrs / Miss /Ms /Dr SURNAME_____ _________ _________ ____

FIRST NAMES_______ _________ _________ GDC NUMBER ___________

CONTACT
ADDRESS_____ _________ _________ _________ _________ _________

____________ _________ _________ _________ _________ _________ _

____________ _________ _________ _________ _________ _________ _

____________ _________ _________ _________ _________ _________ _

POSTCODE____ _________ ____ CONTACT NUMBER ____________ _________

E-MAIL
ADDRESS_____ _________ _________ _________ _________ _________ _______

I enclose a cheque for £120 made out to 'Dentalcpd. I understand if
the
course has insufficient numbers I will be contacted and the cheque
shredded.
If this course is oversubscribed I will be contacted and my cheque
shredded.

Signed: ____________ _________ ____

Date: ____________ _________ ______

Please indicate any specific dietary needs:

If you want to join the information can be completed by cutting and pasting the below, filling in the details and forwarded to ChallengeDOH@AOL.com

CHALLENGE MEMBERSHIP APPLICATION FORM

Please accept this email as a request to join Challenge.

First name

Surname

Address

Town/City

County

Postcode

Telephone

Mobile

Email

Name of University/College you attended

Year of Qualification

Number of years at current practice

Approximate percentage of work (time split) NHS % Private %

Contract value (only if willing to declare)

According to Rosie Winterton, "PCT's are commisioning more NHS dental serives than ever before under this new contract". Technically that is true Rosie, but what you fail to remember is that PCT's never commsioned NHS services prior to April. This is how spin works my friends.

You will notice that there appears to be some stuff missing from this page. Due to some strange shinanigans by the web hosters, the last three months updates have been lost. I have been able to recover bits and peices, but its not exactly what I was hoping for.

As an update, I still have not had a written response to by questions to the DPB. And they are still causing us problems. For example, to the question:

"What do we charge someone who has has a recement crown 1 month after having a band 3 treatment?"

The 3 differant answers arose because we rang up several times because we were surprised by the first answer. But hell, I'm not going to turn down 12 UDA's.

" Sadly I heard today from a colleague in Birmingham who I have
mentioned on here previously, having a recorded delivery letter from
his bank demanding immediate payment in full of his business loan and
penalties.(His house is secutity)

This honest dentist bought a practice built it up to 4000 patients got
a contract value of £70,000,as the test year was his start up year. Had
a practice inspection that described his surgery as Dental Hospital
standard. He has tried to overcome the first six months by seeking
income doing GA sessions in a local hospital to supplement his income.

His PCt have offered only to allow him to bid for an extra £30,000
becasue it's not a hotspot, a two surgery practice up the road has a
contract value of £700,000. He works in an area where two young black
girls were gunned down on New Years Eve two years ago.

What madness is this, that allowed the loss of an ethical practitioner
to bankruptcy, when the PCT pontificate about Clinical Governance and
Quality frameworks.

It's all a terrible tragedy, hope Barry and Rosie sleep well tonight,
because this guy has not slept for weeks."

"An 'accountant ' from the DoH visited a local PCT on Friday
and then moved on to the BSA. The reason was he lives in Brighton and
wanted a chat about the review process so here goes...

PCT's will receive an exception report on or around the 16th Oct this
will highlight...

1.   no and/or low contract activity
2.   Urgent treatments
3.   continuation treatments
4.   free repair and replacements
5.   multiple courses within the 2 month period
6.   low adult mix of patients
7.   late reporting of activity

PCT's are to use this to choose which practices will be reviewed.
Apparently his knowledge of the new contract at the coalface was nil
and he was unaware of the problems at the BSA whose helpline is
blocked all the time !!

We have just started to discuss the review process with our PCT's
great fun only one of the five wants to squeeze our b..l..ks. So we
consider ourselves lucky !
oh forgot to mention the double VDP payments, the double rates
payments , the trainers superann not calculated properly, the trainers
not being paid on the Oct schedule, the private scripts not being
available. "

A survey of dentists carried out by the Dental Practitioners' Association between April and August 2006 has confirmed anecdotal evidence of high levels of dissatisfaction with the new NHS dental contract introduced in England on 1st April 2006.

. 42 per cent of dentists who responded said that they do not expect to meet treatment targets.
. 64 per cent do not have the capacity to accept new NHS patients.
. 50 per cent have signed their contract 'in dispute' and 74 per cent say they signed 'under duress'.
. 95 per cent say that the new points system does not fit well to the treatment provided.
. 80 per cent say that the three-banded patient charge system is not workable.
. 98 per cent say that the target-driven system is affecting clinical decisions.
. Only 5 per cent say the new system is more preventive than the old.

CEO of the DPA Derek Watson said "These figures are very worrying as they show that the drift of dentists away from the NHS is likely to accelerate due to the new contract. This is exactly the reverse of what was promised by the Department of Health. It confirms what we are hearing from our members, which is that they are using the three-year period during which their earnings are guaranteed to plan an exit strategy from the NHS.

"The dental market is a complex one. One result of the points system of remuneration is that dentists can earn the same income while carrying out fewer fillings. This, in addition to the 5 per cent reduction in treatment targets, means that it will be a good year for dentists-but not necessarily for patients. Some are being placed with dentists by Primary Care Trusts but this does not match the number being forced to go private. Dentists are continuing to drift into the private sector due to the large disparity in terms and conditions between the NHS and private sectors.

"The job of finding a solution has been delegated to Primary Care Trusts / Health Boards; but responsibility lies fairly and squarely with the Department of Health which dictates the system in which dentists and PCTs must work. Unlike the old system where funding followed the dentist and provision could be expanded, dental funding is now capped based on historical spending. A simpler and more preventive system which would guarantee access to an NHS dentist was promised by Minister of Health Rosie Winterton MP but it is likely that the new NHS contract will be the last."

The main problem with the new contract now appears to be the new DPB. There are multiple reports of them not giving out the information required by practices to monitor their UDA's. It was only today that I recieved anything that actually had an UDA calculation or a record of claims made. Remind me when the contract came into effect.

I am not surprised by this. The countless updates that are being sent by the download software providers are a classic example of a system that has been rushed through. The new DPB just weren't ready to take on the task required of them.

i am writing to you about the plight of my nhs patients who are now stuck in a crisis due to the my local pct not giving adequate funding in which to treat them.

i have also contacted my local mp, been interviewed by BBC northwest news and ITV Granada reports ( who showed the feature on 7/6/06), Lancashire evening telegraph

http://www.burnleycitizen.co.uk/news/newsheadlines/display.var.788416.0.dentist_stuck_in_care_crisis.php

As far as i am aware, i am one of the first, if not THE FIRST, dentist who has completed their targets with regards to the new dental contract- in fact i have done more than i will be paid for. However my poor patients, many of whom are half way through treatment e.g. crowns and dentures, will not be able be able to see me any longer for NHS treatment as my extremely low contract is now finished.

The initial level of funding which my pct and i were having discussions about in February/march 2006 was during a time of both professional stress (due to the dental contract changes) and more importantly i was having severe family worries/stress. as the pct were pushing me to sign fast (despite being aware of the stress), i felt i did not want to mess them around in any way so i said i needed more time to think due to my family situation and would have to leave the talks and contract at present. after only 8 working days (and before the closing signing date of 31 march 2006), my family problems had gone and i was in the right frame of mind to think and accept the level of contract being offered (despite it being well below my ability, shown by past years. so the likelihood is that i would still complete my target before the end of the year. thus i would still finish the contract and have patients half way through treatment). But the pct said this could not be given now and instead gave me an unbelievably low figure which all my peers are shocked and disgusted about. As a result it is my patients who are suffering severely. It did feel like the pct really did not care about the patients but just wanted to save money

i am the first of many dentists and patients who will find themselves in this situation as they finish their UDA (units of dental activity) targets. When i contacted my local pct, all they said is that my meagre amount of 1925 UDA should have been spread
over a one year period. This is unfortunately a situation where by i am a very willing NHS dentist but am being forced to stop treating my NHS patients due to the pct not
giving funding. Yet if the pct had given me an adequate funding for the high need
area this patient and many more would not be in this situation

our practice recently took on more patients from the NHS waiting list. a gentleman from the pct came to the practice and spoke to our head nurse , who was most alarmed by what he said ; which was as following: that the people who have been waiting the longest on the nhs waiting list are not the ones who will be taken of the list ( i.e. given to a practice ) first. Instead it is actually a postcode lottery and not first come first serve. our head nurse was shocked as we have many patients who are willing to
travel long distances to see nhs dentist and patients talk to each other so she asked him what she should say if one patient spoke to someone else and asked why they had been waiting on the list longer than their friend and yet the friend had a dentist first. The gentleman from the pct told my nurse to just say it is a postcode lottery not how long they have been waiting.

i feel this is unacceptable as patients are unaware of such situations and ultimately it is the receptionist is the practice who are getting abuse from angry patients as the pct is failing to explain such situations to the patients themselves.

the pct have not approached me at all as to how to go about and resolve this situation for my patients despite me contacting them several times since march 2006. They also refused to be interviewed and merely released a lame press statement in which they said i was in some breech of contract as i worked more than 1 NHS day a week. so if they want to take me to court for working harder for my nhs patients who are desperate to see me and for working harder for the same pay as i will receive for 1 day then I suggest they go ahead. At the same time they can explain to my patients who came to see me on the days when for example their dentures were fractured or fillings broken (i.e. they needed non emergency treatment) that i was wrong to see them, as i was only given funding for one day! I feel my patients care is much more important than a mere piece of red tape and bureaucracy. As for the pct statement saying" they are in discussion with me", well i looked the definition of "discussions” on the internet and the definition is an extended communication (often interactive) dealing with some particular topic. The pct have not responded to my many communications at all so the statement is a complete FALSEHOOD.

I got a very strange schedule from the DPB the other day. Although we get paid on the first of the month, they seem to think sending it mid month is a good idea. Cannot understand this myself, nor can I understand the abundance of errors on it, or our inability to contact the DPB........ "we are currently experiencing record demand". But then I expected nothing better and mention this merely for its potential comic value.

The contract is here, and for those who accepted it, there is little that can be done except plan our exit. There is now, in my opinion, no point in complaining. Yes the contract is not PDS. Compared to GDS, it has advantages and disadvantages. Now we must look to the future, and the future is purely within private practice.

There will be some amongst you who think that there is still a future in the NHS. OK, if you are planning to retire in 5 years then maybe there is, but any long term business plans formulated by a practice owner MUST include the absolute necessity to leave the NHS. Dentists will do this on different timescales, with a gradual trickle over the next 3 years leading to a deluge prior to the ending of ringfencing. Of course we will be in election fever then, and many dentists may feel the urge to stay in hoping for a new administration and a new way of doing things. Don't even go there.

Probably the biggest worry is the health of the UK and the global economy. We are seeing a rise in inflation brought about by the inevitable results of easy money and the rising cost of commodities. THis will cause an increase in interest rates across the globe to fight inflation, which may well push many economies into recession. When you privatise, you need to take this into account. Your practice philosophy and your customer service will need to be of such a standard that people will be willing to pay for your services at the very time they are having to tighten their belts. People are more than happy to pay for tooth whitening when they are flush with cash ..... but how many people will want cosmetic dentistry when they are having trouble paying the gas bill. I suspect that many practitioners who convert will do so poorly and will not survive. Those that take expert help, are liked by their patients and who know what they are doing will only grow stronger.

Well we got paid on time, which is a bonus, and the DPB now know who the owner of the practice is........ woohoo. I also have a meeting with my PCT regarding the dispute resolution process, so will be interesting to see how that all plays out.

Another story of joy and merriment from an anonymous fellow. Looks like I am not the only one to suffer at the hands of the Great Machine (if you don't know the reference, buy the book "The Traveler"):

Just about keeping up with the UDAs. Luckily I had a very high UDA value and very few to achieve.

There are two dentists here on an expense sharing arrangement. Despite our signing two separate contracts (in dispute - hours wasted poring over the Contract in a futile exercise, but that is another story) the pay statement has my partner as the principal and me as an associate. After five days of trying I got through to our PCT representative and she explained that the DPB computer system has, in many cases, defaulted to a practice based contract i.e. the Department's preferred set up. PCTs are now having to manually correct this. This problem is common. Who is designated as the provider and who the performer seems to depend on which contact was received first.

Furthermore, I have had my payment under the old system but no schedule. Our PCT rep said this problem is widespread. Some dentists are getting the money but no schedule and some are getting the schedule but no money. At least I got the money! Our rep said not to bother trying to ring the DPB as even she took days to get through on the phone.

Turns out the DPB (or whatever they are called now) think that my associate is the principle of the practice. They say this is because the PCT have given them the wrong information...................... the mere fact that they have been paying ME for the last 5 years seems to be irrelevant. Last week they sent the payment form to be signed by the Provider....... my associate. The PCT said not to change this as it would mean not being paid on time in May, and they would correct matters after 21st April. So we sent the form off.

We had someone phone from the DPB at 16.32 today, the day before a bank holiday to ask to speak to my associate as they hadn't received the forms so that we could be paid. This is the kind of thing you need just before the Easter break. Fortunately I had was able to fax them a copy of the relevant form signed by the "alleged" practice owner.

In all my days I have never known such utter and complete incompetence. I do not know who is at fault here, and quite frankly I do not care. The buck stops at the doors of the DOH who have handled this whole contract implementation like a Soviet Russia handled it's economy. It's amazing how stuff like this focuses the mind, especially when you have patients to treat as well. Fortunately I planned for such an event, and as my associate so very kindly reminded me, it's not like I am living in the radioactive crater that was once known as Iraq.

It will correct itself with time I am sure. Still, not the kind of thing you want to happen. This probably explains why I still haven't even received a stamp yet.

Here are some usefull links. Why there isn't a much publicised web page with all the relevant details on it is beyond me. The government seem far too busy recalling patient info brochures and spinning 2000 dentists leaving the NHS as being a good thing to bother actually telling people how the f**king system works. Or perhaps instead of these really helpfull letters from BC, something along the lines of the oGDS SDR might be advisable. No, instead we will hide all the info you need on 12 differnat websites.........................

Still no contract. Wonder whatever happened to "It'll be with you at the end of the week". Anyway, it could be worse, I could live in Wales

Have found out a few days ago that despite our written offer of
funding for a vt that has now been reduced by £17,000 a year because
Wales does not have the money to fund all 55 vt's in the
principality as promised.

Not only that but VT's have a UDA target!! In England it is supposed
to be around 1,100 to 1,600 UDA's. Wales has unilaterally decided
that 2,600 UDA's should be easily achievable.Whether or not thats
true the whole idea of VT was that it was a year to learn not a year
to hit treatment targets. This is just the start I suspect of using
VT's to solve access problems rather than training them.

A colleague in another health board area has been desperate to keep
his VT and Vt wanted to stay after July but the LHB could not/would
not give him a contract value. VT is now going to work for Oasis down
the road. Oasis will get £40,000 + for"new NHS capacity" and there
is no way colleague will be able to attract an associate with no
contract value.

On the plus side the PCT have realised as of Monday when they
finally went to a meeting that there are these things called uda's
and all contracts will be invalid on April 1st. The financial
director is on holiday but they are urgently asking for info on udas
so they can prepare a contract for the PCT practices.They don't
know when it might be ready ... if only they'd listened to GDP's
months ago when we all told them that it was pointless preparing PDS
contracts starting March 1st when they would become obsolete April
1st. Mind you we went live for PDS last week and still don't know for
how much etc...because we haven't got a contract

Just had my second talk with the PCT. I wanted to keep my very small kids contract. They told me they would like to co-operate, but really couldn't offer more than half of my current UDA value, as it might make all the local GDP's jealous.

I don't see how I can agree to increase my activity by some random number, just to fit the PCT's statisitcs.

Clear breach of the transitional orders if you ask me. Oh, still haven't had a contract from the PCT !!!!!!! I am getting lots of verbal assurances, but it's a good job i didn't have any holidays planned.

Due to computer issues I have been unable to keep this as updated as I would like, but now I am back. See the vile minions of the dark forces cower before the light I shine upon their treacherous faces........ ahem.

Our PCT have said that an nPDS contract is possible without being an NHS body. I have yet to see the nPDS contract, but I have been assured that, because I am in PDS, things will smoothly carry on as before. Time will tell.

The overall reaction from patients has been totally negative. After four weeks of whispering in ears, 99% of the reactions have been "what the hell are the powers that be playing at". I have explained terms in politically neutral language, so I feel safe that this is a genuine reaction. People are not happy.

On a slight tangent, there is a website I know of that reportedly predicts the future. In technical terms it uses computer software to trawl internet website's and discussion groups to get an overall feeling of where the future might be heading. the basis of the technology is that as a global mind, humanity has precognitive abilities and can thus get a sense of what is coming. Whilst it won't tell you the lottery numbers, it will give you (quite accurately it seems) a general syntax of the future. One of the things it has picked up is a "growing militancy" towards the powers that be (and not just amongst dentists). It could all be complete hogwash, but some of the results have been quite interesting, if not vague and potentially "lucky strikes". Still, it is interesting to hear that things like this are going on. Interesting to note that these "Web Bots" as they are known have detected something big happening at the End of March (on an emotional scale, ten times the effect of 9/11). Welcome to the land of WOOWOO

Tum te tum. It is strating to look like RIP NHS dentistry. My comments in lovely GREEN

We are still waiting for out nPDS UDA values. The girl at the PCT
hasn't started on our figures yet! "It's quite complicated you see.
It's all taking longer than I expected to work out." In the meantime,
one of my associates has quit. When I phoned the PCT for a chat, they
raised some interesting points:

1. There will be no negotiation whatsover on the UDA's - take it or
leave it when it finally arrives. To date they have only completed the
figures for one PDS practice.
2. We won't be allowed to go children/exempt only [Does the CDO know this].
3. The departing associate had a smaller than average list, there can
be no negotiation on increasing the list size to accomodate a more
commonplace full-timer. (Despite the fact that we are in a "hotspot"
area.)
4. If we don't replace the associate and her "allowance" is removed
from our PDS agreement, then there is a sting in the tail. She has
quite a few fee-paying patients, my partner and I are mainly children
and exempts already. However, the UDA value for our contract will be
reduced if we close the leaving dentists list, because this will
affect the patient charge income of the PCT [This, i feel, contravenes the transitional orders the PCT's have to work under]. In other words, a fee-
paying patient has a greater UDA value than an exempt one! Or, in
other words, I will have to do more work on my list in order to meet
my new UDA value and get the same - previously agreed as fair - money. [Imagine the headline "PCT says children worthless"]
5. If we have any difficulty recruiting an associate of exactly the
same profile as the leaving one, we are screwed whichever way we turn.
If the is a period with no associate and our patient charges drop - we
not only lose the associates money, our UDA/£ figure is reduced [Patient charges are irrelevant so long as you meet your UDA's]. It
now looks like we will need to go back to nGDS to protect the
partner's UDA values from the comings and goings of associates.
6. One thing seems certain, OUR PCT has no mechanism in place for
increasing anything at any time, or enagaging in any negotiation with
an existing practice. (There is money for new services in the Town -
if provided though a new start practice.)

It all seems very sad to me. The PCT take no responsibility and blame
it on the DOH - if I could speak to the DOH they would probably blame
the PCT. Unfortunately, many patients will only blame me. It can only
get messier over coming months

This PCT needs to be taken to task............... unfortunately, due to the fact that everything is being rushed through (some would say deliberately) this isn't going to happen. I would argue that nhobody should work with a pCT that doesn't play by the rules. Any funny business and you should be off into the private sector. Because if they are doing this now whilst the spot light is on them, imagine what games these PCT's will get upto in the future.

And there's more. It does not surprise me in the slightest how every body who has sent me information wishes to be anonymous. This is the kind of society we now live in unfortunately. It is a shame that every dentist cannot formulate a feeling of mutual trust and respect with their PCT, similar to the one I apparently have with CHesterfeld PCT. Remember though that I did ask for good, and bad stories as I wanted to balance things out. Unfortunately it's all pretty much been bad so far. Here's another example from Wales:

Our LHB gave us three working days to approve our summary PDS
proposal for kids etc. Even a quick examination showed numerous
problems from basic arithmetic (gross=net + supperannuation +
charges not net=gross+superann+charges) to wrong numbers of patients,
no breakdown of how figures arrived at etc. No one would return our
phone calls until 4.30p.m.

Basically we were told that as the figures had to go to the Welsh
Assembly on Tuesday (today) it was take it or leave it. No they
wouldn't give us a break down on the figures (kids + over 65's for
several of us and a full nhs vt list) and they couldn't give us a PDS
ortho contract as ortho had to be nGDS and they haven't got around
to that yet.

There are no othodontists in *******, one hospital list is
completely closed and the other hospital ortho consultant has given
in their notice. What are the people currently under treatment with
us supposed to do? Are we supposed to treat them gratis after March
31st? Thank god we are not reliant on the NHS for adults when we go on
Feb 8th. This time 2 years ago all ******* practices were NHS, most I
would guess 95%. Now no one takes on NHS and there are only three
practices with mainly NHS lists left.

The new year is upon us, and already theChristmas spirit has evaporated. Some PCT's (and the Welsh equivelant) are getting nasty. I have had several people say that they would like their stories posted here, but they are afraid to do so even anonymously due to the vindictive nature of the people they are dealing with. I suppose it is like everything, there is good and bad. There will be good PCT's and there will be good PCT's. The same goes for politicians...... and dentists for that matter. I met one dental nurse over the holidays who says her dentist makes her wear the same set of gloves all day long !!!!!!!!!!!!!!!

Hello my name is ********** and I am an associate in a 95% NHS practice in North Wales. We are converting to practice plan for adult patients in Feb. Why? Because the Welsh assembly and local health board have no idea. The Welsh Assembly will have to approve sight unseen the new contract because it hasn't been written yet and yet nGDS starts in Wales in April as well. The Local Health Board (we don't have pct's in Wales yet) were up to 9 months late in paying us for unregistered toothaches we contracted with them for and then told us when we were owed 4 months money they'd run out of budget.

We have been pleading for PDS for over a year with no reply to letters (last year there were only 7 practices in wales in PDS none in North Wales). November 20th we get a letter asking us to submit a business plan for at least a 4 surgery practice for PDS to be in by November 28th!!!

December the local newspaper reveals Oasis have got funding for two 5 man practices in Flintshire! Flintshire have 34%registered on NHS last year and figure is likely to be in 20's now as more practices have gone. Have had to comply with two formal complaints proceedures because two patients who failed check up appointments and reminders and hence were no longer registered because they hadn't been in in over two years were advised by the LHB to complain because the LHB were unaware of the 15 month registration rule (we haven't taken on new patients for 2 years because of e.g.a 3 to 6 month wait for next appointment). The LHB head of dental contracts 'phoned us up to ask the difference between a principal,associate and assistant. The best thing we did was let local journo's know as we sent letters out. A practice next door to us went private then were phoned up by the LHB 2 months after conversion demanding they revert to NHS becuase they hadn't had their 3 months notice in writing.Fortunately the local paper had run an interview with the Chief Executive in which he quoted from the practices resignation letter!!

In Wales VT money is supposed to be ringfenced. At the moment one of the few things we do know is that the current offer for next year means that our practice will lose £27,000 compared to this year if we have a vt next year. Similar problems in Cheshire have led to a severe lack of VT places as many practices have engaged associates instead.

To 'God Rest Ye Merry Gentlemen'

Shut up you whinging dental folk, let's not have such dismay,
Remember NICE your saviour will soon be down your way
To take you off the treadmill's toil and give you a 'new way'
O-of working in comfort and joy, comfort and joy
O-of working in comfort and joy.

But some did say this saviour was not the promised one,
They told the Angel Ro-osie to stick it up her b*m,
She squealed, "But this is what you said you wanted all along"
Now we'll tie you to contracts of toil, contracts of toil
Now we'll tie you to contracts of toil.

And then wise men were summoned and told to spread the word
This contract is your saviour and not a nasty t*rd
They met the folks and typed the words, the words were quite absurd
But they gave some some comfort and joy, comfort and joy
Yes some fell for the comfort and joy

But when they came to Birmingham they got a dreadful fright
The dental folk revolting and patients knew their plight
The senators got lots of cards, it kept them up at night
Replying to anger and bile, anger and bile
Replying to anger and bile.

I don't know. You go away on a Tony Robbins course for 10 days hoping a few good stories about PDS would have emerged........ only to find it's more of the same. Ok, this isn't so much to do with PDS, but it does pertain to nPDS

Hi , re UDA calculation one of our members has contacted the DPB with
a query, it may have been a slip of the tongue but if the DoH had
taken April to March for the calculation we would have considerably
more money in our contracts! Do not know why but I would have been 15%
better off !

PCT financial allocations , we met Brighton and Hove PCT this
morning, guess what there is NOT ENOUGH MONEY TO PAY US ! I queried this with
the SHA, yes was the reply we know, we have asked the PCT's to tell us
what they consider to be their shortfall by Weds, we have informed the
DoH who have asked for the figures by 31st! Just WHO is doing the
calculation? PCT finance guys appear to have gone home early !

On the topic of Tony Robbins, his Unleash the Power Within seminar is being held next February. If you want to know more, or want really cheap tickets for this 4 day event, drop me a line on info@GDPResources.com

If this carries on, I might write a book........ I will call it "The day the NHS died" :)

Dear all

I have an unresolved issue with ************* PCT regarding VT funding.

It is a long and complex saga complicated by our VT working between 2
practices in 2 PCT areas and therefore having split funding.

Both practices joined PDS in January 2005 in the middle of the VT year.

The problem was highlighted in August this year when the funding I had been
receiving for my old VTs salary was stopped.

This left the practice with a £30,000 shortfall in funding ( the VT salary
reimbursement for a year)

The PCT is insisting that money in the baseline contract which was earned by
previous VTs ( in the 2003-4 baseline) and should be used to fund this
shortfall.

Moreover they have now informed me that when the VT leaves this historic VT
money will be removed from the contract value.

In my cases this "VT money" has been already allocated to another dentist
-the old VT who has stayed on as an associate.

To add insult to injury they are now claiming that the money was there all
along and I should not have received direct salary reimbursement so they
have informed me that they intend to claw back this "overpayment".

The PDS5 submitted at the inception of PDS clearly showed the VT allocation
based on the hours the VT was working in the practice. The PCT signed off
this PDS5

The previous Vts ( in the baseline) had worked more hours in the practice
than the current VT worked. It is this historic VT money ( in the 2003-4
baseline) which they intend to remove from the contract when the VT leaves
even though the current VT has a much smaller CV allocation on the PDS5

If NT PCT apply the same logic to other contracts as they have to mine they
will be removing any historic VT money from baselines.

This is a complete change of policy and is completely wrong.

I am very concerned that they are suggesting it is appropriate to withdraw
baseline contract value negotiated at the inception of any PDS contract on
the basis that it was the activity of a previous VDP.

This has wide implications for training practices. I can't see the
justification for this. One of four things is likely to happen -

1. The trainer will withdraw from NHS

2. The trainer will wash his hands of VT

3. A trainer will grudgingly continue to train, not because of a
commitment to training, but to protect CV.

4. Old VTs who have stayed on as associates and are using their
historic VT CV will be forced to leave

None of these will be good for patients or VDPs

There are many practices across the region with VT elements of their
baseline whether or not they are currently training.

My understanding of baseline contract value was always that it was made up
of many elements, item of service for different dentists, commitment
payments, VT payments, CPD etc etc

We were always led to believe that it was the responsibility of the practice
to deliver that historic contract value in whatever way it could - it did
not need to be the same performers or providers providing it was for the
same level of NHS commitment.

Certainly there was never any mention of the VT element of the baseline
being temporary funding which would be removed if the practice was no longer
training.

VT money ADDED to contract values at the inception of PDS was clearly
identified as being temporary although practices need to be careful that the
PCT does not try to withdraw a full £87890 allocation if this was not the
amount identified for the VT

This is difficult to explain fully in a brief email but I feel that total
contract value is at risk if the PCT apply this logic.

If anyone has any advice or opinion on this or has experienced similar
actions by a PCT please let me know.....

I went on a very good Kevin Lewis course the other day. Although the course wasn't about nGDS, many of the people there expressed the view that taking "The Queens Shilling" was a good thing, as it would allow you to do a slow conversion over the next three years, without having to worry to much about practice income. The ringfencing of dental money will only exist for the next three years, and as such staying in the NHS after this does pose a significant risk. What's more important? Teeth, or ever more expensive Cancer drugs.

Dear all,
Our practice has recently launched a private conversion. Nothing
new I hear. Except it would appear from Prof. Bedi's statements on
radio 4 yesterday that we are the 1st PDS practice to convert.

I posted a while ago regarding our practice build on the promise of
growth funding, our recruitment of new practitioners and our and the
local PCT's amazement at the disappearance of this funding once the
draft contract was released.

We had a fair bit of media interest, local papers, radio Newcastle,
radio 5, GMTV all fairly fair and balanced in their reporting.
unfortunately the local MP then published figures he claims to be
ours for our contract values, patient list etc. these figures are at
best poorly researched at worse false. He states we receive these
values and then patient charges on top as we know absolute rubbish.

I was unsure as to the source of this information until I received
this email "I was upset to see details of the PDS contract values
and the modernisation funds in the recent Journal article. I have
checked within the Care Trust and am assured that this information
did not come from with in the Trust. I am lead to believe that this
may have been obtained by the MP through the DOH direct especially
as the figure is incorrect for the modernisation funds and is the
figure I incorrectly gave to the ministers staff when contacted late
one evening as an estimate." from our local advisor.

Previously the PCT had been fairly touchy feely to the profession.
It now appears confidentiality stretches only until you annoy them.

Do any of you wise men have advice on the direction to proceed?

In Yorkshire we have several new orthodontists. At least two of them
decided at approx age 30 to leave the GDS, go back into the hospital
system as junior house officers, and work towards an orthodontic
qualification.

They built up large debts, and eventually were recognised for higher
qualifications and were entered onto the specialist lists.

They then bought into partnerships, taking on further enormous debt.
And for the first year they have had to bear 12 to 16K a month bills
for their share of the running costs of the practice, including lab
bills and brackets etc.

As you will be aware, the usual run of things, is ortho takes 18-24
months to finish, with minimal intervening payout from the exchequer.

So, any 'annual' contract value in the first 36 months-ish of their
work at a particular address will be lower than the 'norm' in the
period after the initial start-up period.

This practice is very slick, very professional, and very well
respected. The (formerly sole) principal is very keen, and has kept
incredibly well informed on the progress of PDS, nGDS and nPDS. He
has watched carefully the BoS (British Orthodontic Society)
negotiations with DoH, and has managed to calculate what a 'UOA' is
worth in their practice, in the current general dental services.

They foresaw problems over the transition, with two new partners, into
a new contract, and so they applied for PDS 2 years ago, and were
blocked from applying by the local DDPH (not a priority?...), in
direct contrast to practices in the two neighbouring PCTs that are
within the same Strategic Health Authority, despite the fact that
their own PCTs DDPH is the same as the StHA's DDPH!

Yesterday, I am told, they were informed that their contract values
for the next financial year would be for the year ended 30 Sep 2005,
and the 'start-up' nature was going to be ignored, as there is no
growth money locally. To add insult to injury, the UOA value is not
going to be based, they are advised by the DDPH, on their previous
workload, as the 'gross contract value' is, but on the national
average for UOAs. So their £70 per UOA, for their workload, is going
to be cut to £50 to £55 per UOA.

They are advised by those in the know that they will get 70% of the
total treatment costs for incomplete cases, even the ones one day from
completion.

So the net effect on the two new partners is:
Gross halved for next year.
Not paid for the work that they have done fully
To achieve their 'halved' gross figure, they will have to 30 to 40%
more than half their previous workload.
Probable bankruptcy. In a big big way.

There are lessons for us all here.

I have thought long and hard about what to write next, but my
knowledge of the torts of libel prevent full coverage!!!!

The main lesson we all need to learn is
THERE IS NO NEW MONEY
THERE IS NO GROWTH MONEY IN PCTs.

Any practice with an anomaly, like a new associate, a VT just moved to
associate, maternity, sickness etc etc is stuffed

This is truly outrageous. What occurred to me today is that those who take up nGDS/nPDS will be entering the NHS system for real, and the NHS system is a complete and utter shambles. I will give a brief run down of what I mean:

Yes I can see dentists taking up the nGDS/nPDS baton and running with it, but many will be doing so only for the guaranteed three years or less. This is turning out to be a f*ck up of immense proportions.

I got a letter earlier in the week from the PCT. Apparently they are concerned that our patient charges have dropped (neither my practice or my PCT have any idea regarding vast swathes of data concerning those who don't pay for treatment. You could do a million crowns on exempt payments, and yet that would not count towards anything). I sent my response as to why this occurred, and phoned the PCT representative, who is very approachable and comes across as very competent. It would appear that the PCT's have had this all dumped on them, and are getting no help from the DPB the DOH or the ministers. It is apparent that, come D-Day, the PCT's will not be getting the full contract value for each practice already in PDS. They will be getting the contract value MINUS an historical average of patient charges received. It is likely this will be the case for those in the present GDS to. I don't swear often, but this is no way to f**king work things. Patient charges received, by their very nature will fluctuate, and this is just another unnecessary financial hurdle for overburdened PCT's to overcome. The DOH are pinning PCT's into a corner and if it carries on like this, I really cannot see things working.

I get the feeling that the PCT's are scared. Everything is untrialed, brand new and likely to go belly up. This could turn out to be a very big mistake by the government.

If you are a dentist in the UK, and not a member of the GDP-UK Yahoo group, then you should be. The BDA and the DPA are not going to give you the information you need. GDP-UK has over a thousand dental members, and includes some of the top names in the profession......... the people who know what is going on. Follow this link and join today -

I have just returned from a meeting in Manchester, well organised by *******, in his role as Post-grad Tutor. It was in the Question Time format, questions posed by the audience, and a panel consisting of Michael Watson [Independent healthcare consultant specialising in dentistry], Roger Matthews, [CDO Denplan], Chris Audrey [former practising dentist, now DH] and Lester Ellman [Chair GDPC].

Overall, many of the questions and answers were rehearsed here, but Chris Audrey certainly showed this very biased onlooker how out of touch he is with the dentist in practice. He was literally laughed at with some of his comments about charging for FTAs, and Lester repeated comments that the charging is all about the threat, not the value. Someone asked could GDPs be credited with UDAs for PFAs - Chris Audrey answered with "how will the PCT know a dentist is telling the truth?"

Chris Audrey repeated the threat [already debunked here] that if a dentist does not take up a contract, the money will go to his colleague down the road.

The whole panel agreed it would be morally and ethically correct for a dentist to provide private treatment for less than £183 if a treatment plan would cost that on the NHS, but would attract a lower private fee. the question then came that if dentists then did this, how would they keep their UDA count going?

Regarding children, there will be contracts, as we know, that can be restricted to patients under the age of 18 only. However, Chris Audrey was adamant that these contracts would still contain the non-discrimination clause, which would therefore be contradictory, within the contract. Exactly the same as having in the contract a clause that allows a dentist to do posterior composites, then the next clause says the dentist cannot.

Regarding control the DH wants to establish, Roger Matthews pointed out that the old terms of service was around a dozen pages, the new contract looks like being 159 pages long.

There was another [minor] row when Chris Audrey explained that bonded crowns were removed from GDS in 1996 following a report from a dental school that full coverage shell crowns preserved more tooth substance. John Mooney remembers the money was saved in order to put more into children's capitation. I personally do not remember the scientific argument, but I do remember the Govt, in 96, doing this to save some more money.

Revised draft contract regulations -
Info as at 10 November 2005

Numbering refers to the revised draft contract regulations.

1. Core hours (redrafting- minor policy change?)
"Core Hours" has been redrafted to instead refer to `normal surgery
hours'. This was to end any misinterpretation that these hours were
the required opening hours, which they are not. Opening hours are for
local agreement.

Amendments at reg 2 (interpretation), reg 14(3), sch 4 para 14
(patient information leaflet),

2. Electronic forms (minor policy change)
Electronically generated forms will be allowed for all forms apart
from prescriptions e.g. you will be able to generate your own
receipts etc as long as they include the required data. Previous
drafting permitted electronic forms only in some circumstances

Amendment at reg 2(2) (interpretation)

3. Corporate bodies (redrafting - no policy change)
To clarify that a new corporate body must be registered with the GDC
prior to entering into a contract.

Amendment at reg 5

4. `Advice and planning' (redrafting - no policy change)
Redrafting to clarify no changes to mixing regulations regarding
mixing advice and planning of treatment. The DH have now clarified
that, apart from the same-tooth rule, the mixing rules are
substantially the same in the new arrangements as currently.

Addition of `advice and planning' at reg 14(4)(c)

5. UDA tolerance (policy change)
2% tolerance of UDA requirement extended to 4%, but still to be made
up within no less than 60 days.

Amendment at re 19(2)(b)(1)

6. Mid-year review for in-year starts (minor policy change)
Additional text to cover reviews for contracts commencing mid-year,
where a rigid six-months would be inappropriate. The review would
happen at a time agreed with the PCT.

Addition at new reg 24(3)(a)

7. Completion of treatment (policy change)
Regarding the previous drafting, requiring courses of treatment to be
completed within 90 days. Treatment needn't be completed within a
specific time, but instead within `a reasonable time'. For
orthodontic work this was previously 36 months, for mandatory
services this was previously 90 days.

Amendments at sch 1, para 5(3) for ortho and Sch 3 para 6(2) for
mandatory services

8. Termination of CoT - `irrevocable breakdown' (policy change)
There is the addition of `irrevocable breakdown in the patient-
dentist relationship' as legitimate grounds for the contractor to
terminate a course of treatment. This will require prior notice to
patient and for the PCT to be informed.

Additional at sch 1 para 5(5)(iii) and sch 3 para 5

9. UDA for incomplete treatment (minor policy change)
Change to reflect charges for incomplete treatment. This would cover,
for example, a patient who has a crown made but never has it fitted.
The contractor receives the full UDAs but the patient only pays a
band 2.

Amendments at sch 2 para 3(b)

10. UOAs (minor policy change)
Redrafting to allow for UOAs for case assessment and start of
treatment and to allow for inceptive orthodontics for children under
10 (not previously included).

Additions under sch 2 para 4 and new text at sch 2 para 4(2)

11. Children and exempt-only contracts (policy change)
Redrafting to allow a contractor, with agreement from the PCT, to
restrict services to children only (for example). The scope of the
text appears to allow restrictions on the basis on the patients
exemption from NHS charges status and other factors also but with the
specific agreement of the PCT.

Additional text at sch 3 para 1(3).

12. Violent patients (policy change)
Redrafting to follow drafting of current GDS regs (so, allow scope
for abusive patients to be refused services, even though `abusive'
may not specifically be mentioned)

Amendment at sch 3 para 3(1)(a) and sch 3(6)(5)(iii)

13. Care and treatment summary (minor policy change)
Addition of requirement to provide, on request of a patient, a care
and treatment summary (omitted from original draft - similar to
current GDS regulations)

Addition at sch 3 para 7(6)

14. Repairs and replacements generating UDAs (policy change)
Removal of text which had previously stated that provision of repairs
and replacements would not generate UDAs.

Amendment at sch 3 para 11

15. Qualification of DCPs and employment (redrafting to fit s60
order changes)
Change to cover eventuality of s60 order not being in place by date
of implementation of these regulations.

Additional wording re DPC qualifications at sch 3 para 22 and
employment at sch 3 para 25. There is an additional minor amendment,
to confirm to s60 doubts, at para 71.

16. Training for DPCs (redrafting - no policy change)
Restriction on training requirements to DCP via clarification that
this paragraph applies to dental practitioners and dental care
professionals only.

amendment at sch 3 para 28

17. Patient records (minor policy change)
Addition of PR form and lab docket to definition of record

Amendment at sch 3 para 32(4) for the PR form and 32(3)(c)
for the laboratory information.

18. Property rights (redrafting - no policy change)
Redrafted sch 3 para 32(5) to say "nothing in this paragraph shall
affect any property right which the contractor.". This is to clarify
that the contractor owns the patients' records.

19. Notification of courses of treatment (redrafting - no policy
change)
Redrafted to clarify all circumstances under which a case start
should be notified and to add clarity linking UOAs to case completion

Amendment at sch 3 para 38

20. Death of contractor - termination (policy change)
Redrafted to extend timelines to 7 days, with an additional 3 months
and then six months (i.e. total over 9 months). The right of 7-day
termination is retained (to be used in exceptional circumstances).
Previously this was 7 + 28 days.

Amendments at sch 3 para 65

21. 18-month notice from PCT (policy change)
This is revised entirely to now state that "The PCT may only
terminate the contract in accordance with the provisions in" the
contract i.e. breach of contract, not 18 months notice.

Redrafting of sch 3 para 69

22. POT checks (minor policy change)
Requirement to establish a patients' exemption status - Point of
Treatment checks - is added; this was omitted previously.

Hello Folks - well, we were all ready to commence PDS on Nov 19th. I got an email from ******** PCT saying - good news the contract has been approved! However, a quick look at the figures revealed that instead of a 5% increase in patient list for the same money, we had to service a 10% increase in patient list for the same money. After querying this, we also discovered we had to guarantee that patient charges would be undiminished over the period Nov-April 06. We believe this is actually impossible. You can guarantee turnover - but, not patient charges over the initial six months. If you increase patient lists dramatically - the short term effect is a
drop in patient charges. The end result? Oh dear! a good healthy mixed practice, which treats 4500 NHS patients and three thousand private patients and which has a good reputation and loyal clientele - will be forced to go completely private next year. It has taken a real effort on the part of the PCT to turn us in this
direction. To be frank, I strongly resent the way we have been treated over a period of more than a year of negotiations. A new era of trust? More time to spend with patients? Pull the other one. Our socialist ministers are simply incompetant capitalists. They will no doubt open a polish dental practice in the town next year on the grounds that the money-grabbing dentists down the road were too demanding. I think Baldrick is alive and well and working down at the DOH - they think they have a cunning plan!

Rejoice, for I have good news. I have a positive story............ and as luck would have it , it is mine.

Due the obvious concerns with the draft proposals, I requested a meeting with the PCT. Now, despite what many of you think, I am an optimistic kind of guy (it sort of comes from going on so many Tony Robbins courses). The meeting with the PCT went very well, and I was reassured on numerous points:

The only question mark is what treatment can be done under the NHS. We have the letter from BC stating that cosmetic treatment is a no no on the NHS, but this is not official policy as of yet. I am not naive enough to think we are totally out of the woods yet. As my Grandfather used to say:

"Hope for the best and plan for the worst. The you won't unexpectedly find yourself swimming in sh*t". Even when I get a contract I am happy with and that I can sign, I will still have plan B in the background ready to go. The patients are being prepped as I write this :)

Here's the current state of play in my neck of the woods.

A "friend" converted to PDS, at the same time expanded with some
investment in his practice, and took on a new associate.

The practice agreed to take on a substantial number of new patients,
growth money was agreed and work began.

It now appears that the PCT is facing a large deficit in its finances
because of the well documented fall in Patient charges for PDS and particularly in
this case because the growth money comes from the DoH with an element
included for Patient Charges.

This element is apparently calculated using some national average formula.

My "friend" has looked at his data and found that approximately 80% of
the new patients taken on under PDS are exempt/kids. The PCT has
requested the data from the DPB on this.

What a state of affairs. My "friend" has told the PCT that the growth
money has been well spent on the poor and vulnerable of Bradford and surely this must be seen as a success for everyone except the PCT finance dept?

Meanwhile, there is mood of despondency and "what's next?" within the
practice, my "friend" is fearful for the future.

The theme that appears to be coming out is that in no way should you make business plans based on promises for nGDS / nPDS. You should not make investments in your practice based on PROMISED money from either a PCT or the DOH because said money may not be forthcoming. Remember one in five NHS trusts are basically broke.

I have asked dentists to give me their PDS experiences. I had hoped for good and bad, unfortunately I have only received bad so far. Hmmmm. This from someone who is a tad unhappy.

PDS worked well for me too, however I wanted to specialise in Orthodontics. I was assured that our application would be approved,that was in APRIL 2004, naive or what? So to cut a very long story short I sold my "successful" PDS ordinary practice invested half a million of Nat West's money in a specialist centre as we were told this would be the New Way of Working.

We have have had repeated assurances we will get PDS. Not so far . I personally feel "let down", "hung out to dry" on a good day I don't think about suicide.

Currently the PCT is talking to the SHA. We were promised PDS over 2 years ago. If it had not been promised I would not be here in this predicament!

There are rumours on the wind. Whilst we cannot vouch for validity of said rumours, we include them for your consideration:

Here is another story, from ANOTHER disgruntled dentist. I am DEFINETELY beginning to detect a theme here

We went into PDS November 1st and were promised a changed way of working. More time for prevention and an aim to improve the oral health of our patients. The measure for funding was to be time spent and service of a notional list of patient who have attended over the last 5 years plus provision of access to emergency care for any patient with pain for 1 hour per day. Our 2nd year associate was provided with £9600 per month for full time commitment. She accepted on the grounds that there would be an increase in line with the national guidelines when she entered her 3rd year on August 1st 2005. She has expanded her list. In old terms she has 2200 registered patients plus another 2000 on her notional list, plus the PDS emergencies. Her pay increase was refused and will not be considered until April 2006. We have started a building extension to provide her with another surgery to house a full time hygienist surgery when she buys into the practice. The capital improvements cost £120,000. The PCT now tell us they have no money for expansion; are no longer interested in oral health; only patients charges and UDAs. ( Whatever the hell they are. The PCT don’t know either! ) We have no alternative but to privatise the expansion. April 2006 will be too late.

We are calling for a vote of ‘NO CONFIDENCE’ in the DoH and the PCT commissioning capacity. It is essential that we put a stop to the constant media coverage telling the Nation how happy we are with the governments changes. The profession must tell the public the truth before we are blamed for not accepting their new terms in 2006.

On a different note, it FINALLY looks like I have my insurance sorted out for the flood, which was only about 7 months ago. They make politicians seem positively efficient.

Well the stories are now coming thick and fast. The DOH's much celebrated scheme to entice dentists from abroad may not be as good as they make out, as one dentist tells us.

As you know the CDO went to India to entice Indian dentists with a
picture he painted of a country desperate for dentists and keen to help
Indian dentists come to England and fill the NHS vacancies. The deal was as
follows. The Indian dentists would sit IQE A in India. If they passed then
the DOH would provide £15,000 of funding to the PCT to employ that Indian
dentist in one of their NHS practices to work as a clinical assistant. The
extent of the position was to help in any way in the practice short of
actually working on patients as a dentist. So the Indian dentist could work
as a nurse, or an extra body to help out in reception, or with sterilising
or whatever. They would also have one attempt at IQE B & C paid for, and
receive time off for study.

It was a really good scheme. The practice got a free body to help out, but
one who really understood dentistry. The Indian dentist got work permit, two
days study leave a week, the opportunity to observe British dentistry, and
British dentists at work, one attempt at IQE B & C. This was a real win -
win scenario.

When CDO went to India I really believe that he believed what he was
saying. Unfortunately the DOH do not always apparently act honourably.

They did not promote the scheme to practices or PCT, and the scheme was set
up in a way where the PCT had to approach the DOH for access to the Indian
dentists, but if they knew nothing about it, how could they make an
approach.

The DOH have now stopped the scheme dead in its tracks. Any Indian dentist
who has not already been approached for interview for one of these clinical
assistantships will no longer be considered as the DOH has withdrawn future
funding. This is a scandal. In my opinion it is a clear direct breach of any
sort of moral or ethical code. Utterly reprehensible.

Indian Dentist A and I have been talking for some time about coming to my new
practice, and we were able to get interviews sorted out before the funding
ended, and I was able to convince the local PCT that the scheme was worth
supporting. Indian Dentist A came over to England, and met the PCT. They were
instantly won over, and they are supporting him and this placement with
every fibre of their being.

The DOH have been as difficult and obstructive as it is possible to imagine.
Finally we are about to crack the problem only because of the support of our
local PCT. So many messages tell us of the difficulties dentists are having with PCT's, mine has been absolutely superb, you could not ask for a more supportive PCT.

I feel desperately sad and terribly embarrassed for all the other Indian
dentists who had placed all of their energy and effort into the scheme, only
to be shunned so blatantly.

Have you notices a theme here. Every one of the dentists in these stories have insisted they remain anonymous. Some are actually afraid of what the government and the DOH might do should their whistle blowing come to light. I personally don't feel the DOH would do this. I am sure they are good people doing what they think is best. They just seem to be mistaken and have chosen to go with an untested scheme without getting the backing of the profession who would have to carry it through. I am sure they will do the right thing for the people this will really effect........ the patients.

I want to make a statement here. It is not my intention to embarress the governemnt or the DOH with this blog. I am more than happy to post positive stories as well as negative stories. Unfortunately everything that has come my way has been negative so far. So if you feel nGDS is the best thing since sliced bread, please write and let me know

Here we go again. A politician was on the Today programme this morning where she blamed the NHS dental crisis on dentists "abandoning" the NHS for private practice, and was not challenged on this point. So the fact that dentists are self employed contractors able to choose their own destiny is irrelevant I take it. And I take it the progressive fee cuts that made many NHS practices unviable is also irrelevant, or the ever growing folders of regulations and rules that NHS dentists are forced to work under. If by "abandon" the politician means dentists making a business decision and taking the most viable option for them, their business and staff, then I welcome the 40-50% of NHS dentists that are likely to "abandon" the NHS come April 06. I applaud the practitioners who value their health and their financial well being, who look to create a future for their families and their staff by "abandoning" the NHS.

We had an interesting meeting with our lead from the PCT the other day... We have a VT which we have not been paid for yet and have been told the DOH are not likely to pay either! Or if they do it won't be for the whole year...
Also he said that he is getting no joy out of anyone at the DOH as they are either not answering any phone calls, e.mail's or have left on long term sick!!

I suppose deep down I am frightened, yes frightened , to make the leap to private dentistry.We all have financial and family commitments and to rock the boat financially is a scary thing. Although , I hear you say, God knows what will happen financially next year!! (Maybe God does know!!)
It looks as if a practice goes private it will have to be all private in April 06 inc. children and non paying adults. We have our practice in the middle of a housing estate. Most of our patients are exempt. We are well thought of which is great, but I just can't see how it will all balance out.

This was originally intended as a blog of my PDS, but with the way things are going, I feel a record of the way things are going is more important. If you have any stories that you feel should feature here, please email them to me at

Still waiting for the insurace company to get their act together regarding the flood. They sent an interim cheque, but there are still invoices that I have paid that have not been reimburesed. I won't comment any more except to say "OVER 6 MONTHS" and "ROYAL SUN ALLIANCE". You can make your own judgements on this matter.

Oh, things get better and better. This story comes from another dentist experiencing problems with "the new way of working".

We are a ****** Based training practice with a new VT appointed and started work
01/08/2005.

Working under the O4C contract we were approved for VT funding by the
Modernisation Agency, over and above our agreed base line contact (11/03/2005)
and all seemed fine. We installed a brand new surgery from scratch, appointed a
new nurse, took on an excellent new VDP and all seemed to be going so well.

When we received our first DPB payment schedules we noticed that the only VT
payment made to the practice was the VDP salary, and this had been deducted
from one of the partners in the practice schedule pound for pound. On contacting
the DPB they informed us that they had not been given any additional funding for
us, so they had just taken the VDP's salary from elsewhere (the trainer's base
line contract in the case) . (Not a word to us about it).

On talking to the PCT/Modernisation Agency it seems that their funds are
insufficient to pay all that had been promised, and funds are having to be
prioritised and re-negotiated. The PCT are very supportive and seem extremely
embarrassed that this has happened, but say they are getting no replies to
'phone calls and e-mails to the Dept.so can do
nothing.

In the mean time I am paying the VDP's salary, her new nurse's salary, her lab
bills, material bills and all the other costs, whilst forwarding her patient
contributions to the PCT.

Is any one else in the situation, (I believe there are others) and what should
be done about it.

I suspect the problems with the new contract will be immense. I also suspect that the sh*t hasn't even been thrown at the fan yet.

There are more resources becoming available regarding nPDS / nGDS. One such resource can be found here, a Q&A page from the Primary care contracting website -http://www.primarycarecontracting.nhs.uk/116.php#0.

The following is from another dental practitioner who gave the nGDS/nPDS contract to his staff for their opinions

They've picked holes in it all without much help from me - especially some
of the practical aspects.
As a practice we are definitely NOT change averse, but they are having
difficulty seeing how the proposals can possibly benefit either patients or
practices (...think they are starting to understand that is not the object
of the exercise!). They are particularly concerned about how the changes
will affect the patients whom we know and love; those who have been loyal
patients at the practice for years - and how they will deal with the
disappointments of those patients and their demands.

So, feedback so far:-

1)"How are we going to control the appointment book within the rules and
look after our loyal regulars? We have a constant stream of lapsed or new
patients wanting NHS examination/treatment - and we just don't accept these
people at the moment. If we just have to accept patients up to clinical
capacity, how are we going to be able to offer a service to our regular and
loyal patients when space has been taken up by lapsed or new people?"

2)They are very worried indeed about the conversations they feel they will
inevitably have with disgruntled loyal patients who will have to be told -
"I'm sorry, I know you've been seeing Stephen for 20 years, but the NHS has
changed now and no one is registered anymore. Unfortunately we are up to
clinical capacity at the moment and so can't offer you an NHS appointment
here."
"It's a recipe for stress and angry scenes...and it's not going to do our
reputation any good is it? Either that or you'll end up being soft and
seeing them anyway and making yourself ill with overwork (again)"

3)"Is it the same money then, but more patients and you don't get paid more
if people need a lot of treatment?"

4)"How can we possibly get all courses finished in 3/12? We don't manage it
now, and that is without us having an increased number of patients who
haven't seen a dentist for a while and will probably have larger treatment
plans."

5)"So are we going to have to count up all the UDA's to make sure we do
enough but also be really careful about what we're spending on lab fees
every month as well? Brilliant - can't wait. What if someone need a new
Cr/co and we haven't any lab fees left but we need some more UDA's?"

6)"If an NHS patient is going to be paying £183 for a crown or an acrylic P/
with a couple of teeth on it, they are going to want it looking like a
private job. They aren't going to understand that we don't have anymore
money for lab work."

7)"If they have a crown done and it costs £183, they are going to want you
to replace their P/ as well, or replace a couple more crowns as well, since
it won't cost them anymore. They are going to put a lot of pressure on you."

8)"If we get patients who need quite an amount of treatment, we might only
get credit of 3 UDA's for each of them. We could spend hours and hours
getting up to a small total of UDA's. We might not reach out contract total
and have our funding reduced even though we are doing proper treatment.
It'll be alright for ****** practice I suppose, they only do half the
cavities anyway."

9)"What would we do if we got another case like Mr ****. The Restorative
Consultant said we needed to do those RCT's, provide those crowns and do the
cr/co P/P's? We'd only get 12 UDA's and the lab bills were massive.....and
it took us hours and hours and over 6 months! We'd have to find some way to
get rid of him wouldn't we. It doesn't seem fair on him or us."

10)"This can't be right Stephen, but we've just worked out that the NEW
patient charges for all the NHS we've done this morning, would come to more
than all the gross fees you're getting for it all".

11)"No charging for FTA'S? That's just *&$$%*% stupid."

12)"I don't understand about this released capacity thing, we really need
lots more time just to talk to people about medical histories and things, we
won't be able to see anymore people really."

13)"Do you remember Chris Barrow going on about that Quality, Price, Time,
triangle thing, and that you can't have all three of those things at the
same time - something has to give. Well that's what they're trying isn't it
- quality, low fees and quick. Can't work, can it?"

I don't honestly think any more need to be said. The treasury are apparently concerned by the £20 million in patients payments that hasn't been collected, due to dentists moving to a preventive model (and yet they don't seem overly concerned by the £20+billion overspend in the NHS IT system......... go figure). There is bound to be an initial fluctuation in the revenue stream. It took us over 6 months to acclimatise to the new way of being paid (not the new way of working because I have been working towards this preventive model for the last 5 years). So this proves that there was never any interest in the promotion of dental health. How can you promote dental health when your practice has basically been turned into a drop in centre. Someone somewhere has dropped the ball.

There are some who hold the view that the new contract is in essence an attempt to force dentistry out of the NHS, whilst letting the "greedy dentists" get the blame for what may be an unprecedented collapse in NHS patient care. I have not quite fallen into that category as of yet, and I am feeling mightily peeved. Let us not forget how things will soon go. Those close to retirement will cling to their pensions, whilst the newly qualified will go as quickly as possible into the private sector.

Marvelous. I am sat here after reading nGDS and nPDS, and I find myself asking "What was the bloody point". The nGDS/nPDS contract that is being proposed is completely unacceptable, and will do nothing to improve the oral health of the country. It is a recipe for disaster, and in its present form will force decrease the number of dentists providing NHS dentistry by at least 50% (IMHO).

• What exactly was the point of rolling out PDS? Many of us have been in for less than a year and now the whole thing is being changed again. I know many PDS dentists who feel betrayed by this government, and are actively working on private conversion.

• My perception is that you can only get rid of a patient from your practice if they are violent or don’t pay their bill. THAT ALONE is reason enough not to take the contract. As many people have been saying for years, myself included, the whole basis of having a successful practice is to exercise your right to get rid of D patients. I for one do not want to work in a glorified access centre.

• Units of Dental Activity or UDA’s now replace the fee scale. Where as the Treadmill under GDS was a choice and not a result of the system, the Treadmill under nGDS WILL be a result of the system.

• Doesn’t the concept of UDA targets directly contradict the GDC guidelines on setting financial targets?

• Repair and replacement will not count to UDA’s – COMPLETELY UNACCEPTABLE.

• The PCT will be the one that determines the nature of the Clinical Governance by which the practice must comply. I suspect these guidelines will vary from PCT to PCT. See schedule 3, 77(1) – page 53

• It would appear you can no longer have children only contracts as per Schedule 3,1(3) – page 25.

• You have to finish the course of treatment within 90 days. Whilst I have no problem with this, there are many practices where you wait 90 days or more just to be seen. Oh of course that’s the treadmill that this new contract will get rid of isn’t it.

• The banding of patients charges will undoubtedly encourage some NHS practitioners to offer private alternatives below the NHS fee. I wonder if said practitioners have actually worked out their hourly rate?

• If 12 UDA’s is the equivalent of 1 crown or 32 crowns, one questions how the number of UDA’s needed per year can be calculated fairly. It certainly cannot be calculated on the GDS gross. Just think of the nightmare faced by the NHS dentist who did full mouth rehabs, which would be one band C treatment under nGDS.

• I notice from 4(3) page 10, those dentists working for a corporate body better hope the director, chief executive or secretary of said corporate body better stay out of trouble. What about associates whose principles fall foul of 4(3). One suspects contracts will be practice based, with performers income dependent on the provider. This is of course my perception and it could be wrong.

Things are not well in the land of PDS. There are murmurs of dissatisfaction and tales of whoa. Not from my PCT I am happy to say, but from others in the land.

"As an example, a VDP who is about to finish VT has built up a "new" NHS list from zero to 1200 in under a year and wishes to stay on in the same Training Practice to continue NHS care for these "new" patients, as an Associate.

Want to guess what the PCT has offered as the "total" Gross NHS contract value to look after the Dental needs of these patients from Aug.2005-Aug.2006 ?

Answer - £30,000 annually.

Not £30,000 salary for the post-VDP Dentist, that's £30,000 gross, which even at 50% Associate payment gives the Dentist a maximum £15,000 annually, assuming NO lab bills at all !!!

That translates into a £12,000 pay cut for the current VDP from her VT salary now, if she stays NHS PDS there :(. This is a full-time job because these "new" NHS patients all have high Dental needs that's ongoing.

Clearly the Principle was NOT happy and this has only come to light recently because it takes PCT's 12+ weeks to make an offer from requesting a PDS contract.

Apparently the PCT says the Principle shouldn't worry because they have a "Polish" Dentist who can step into the "vacancy" should the current "VT" Dentist not stay on, who apparently will work for these low fees !!!

That's still a "poor" deal for the Practice owners though IMHO.

I know the early PDS contracts got the "best" NHS deals of about £70 a registered patient and there has been downward pressure on this figure for the last 12 months by PCT's, but 1200 divided by £30,000 gross is less than £26 per person per year - ouch !!!

This has greatly upset this VDP who actually is a caring, competent individual who has set out to make these patients, who previously had no NHS access but are of high treatment need, dentally healthy in phases - it is still very much unfinished business!

However continuity and Quality of care appear to be taking second/third place to gross-under funding in this "new" way of NHS working.

Does anyone know of a worse/similar scenario to this?

Currently the VDP is panicking now because even if they apply somewhere else for a PDS Contract, it takes 12 weeks for PCT's to even consider the request, never mind put a "value" upon it. She has loans, mortgage and holiday costs to fund now etc.

You won't be surprised to hear that she has lost ALL faith in an NHS system that doesn't seem to care - will this kind of approach make young Dentists avoid the NHS system even more than before or get out of it sooner?

Obviously she can work Privately straight away and now this is looking more attractive every day!"

This is a worrying development, and I would like to thank the dentist who passed this information onto me.

     At a recent LDC meeting, Fay Brook, of the BDA, gave a 30 minute presentation on the current state of PDS contracts and took 20 minutes of questions afterwards. The advice given is to read your SLA carefully and seek BDA advice before signing. Under any circumstances, no practitioner should go live on PDS until the above requirements are satisfied.
      In general discussion, it would appear that the Department is vetoing growth. PCTs can withhold funding if not satisfied with output or access. A dentist, however, can appeal to someone from another Primary Care Trust but not an independent person. One dentist lost 30% which was withheld by his PCT as he had not met targets.
       Notional list were “subject to capacity”, and the “Access dividend” was usually set at 5% although one or two had been set at 10%, the time available for extra patients being gained by adherence to the NICE guidelines (a reduction in courses of treatment, less intervention and freed up capacity). We were told that all NHS treatment to all adults and kids would be within a PDS contract
      Fay thought that we may lose control over patient “list” and that the list may become the “property” of the Primary Care Trust.
      Practices were expected to have 90% of charges baseline – or the Primary Care Trust would ask questions.
       It emerged that the DPB are inflating numbers by double counting and this was worrying. Maternity ands long-term illness details had yet to be satisfactorily resolved and more worryingly, Seniority may be phased out.

It is now 2 months since the flood. I waited a good 3 weeks before sending in my report to the insurance agency because you have to give water damage time to rear its ugly head. It took 5 weeks with almost constant use of the dehumidifier for the surgery to dry out.

Unfortunately that report sat on somebodies desk for two weeks without being passed to the person in charge. It then took another week for that to move through the system. It then took numerous phone calls to try and get through to the individual, and I eventually had to phone the Dental Buying Group (who arranged the insurance) and give them "feedback" about how slow things were going. Last Friday a guy came out to check that what I had claimed needed claiming, and he agreed with me on every point. I was told that things would now "move quickly". So quickly that I had to phone the bloke in charge of my case on wednesday to see what was happening. He said he was too busy to talk to me, and that he would phone back in an "hour and a half". Well, it has now been over a day and a half, and still no phone call.

If I wasn't in PDS I might be a little bit peeved about this. I just want to point out the the Dental Buying Group themselves seem very good, and are just being apparently let down by third parties. Of course I am sure there is a very good reason for all this..................

If you are contemplating going into PDS, or if you are already in PDS, you MUST, I repeat, you MUST go to the full day lecture by Kevin Lewis, organised by Pappillon training. Here is the link -http://www.papillon-training.co.uk/ . The stuff you learn from Kevin is so potentially scary and business shattering, if you don't know it PDS will be a MAJOR RISK. The PCT's, the DOH and the DPB will not tell you any of this.......... and neither will I because I want you to go on Kevin's course :)

The important thing to remember about a contract is that it is only valid once both parties have signed it. So when I phoned the PCT a few weeks ago to ask where my copy of the signed contract was they went "Oh, we'll get it to you". Well unfortunately they didn't, in fact they later phoned me to tell me they had LOST IT (remember that I sent the signed contract off by recorded delivery BEFORE we went into PDS which was last December).

I only spotted the third aspect at first, and when I informed the PCT that the contract was different I was told that there would have to be a discussion within the PCT about this. I finally get a letter that states the notional list should indeed be 30 months. I still do not have a contract, so it looks like I am in an uncomfortable position.

I mention this not to try and embarrass the PCT because I understand that mistakes can happen, especially within government agencies. I have every confidence that they will sort this out quickly, and that a contract can be signed. I mention this because anyone thinking of going into PDS needs to be ready for potential hiccups such as this.

It is not a bad thing to not have to worry about practice income whilst you take the time to get the building dried out from flooding. We are into week 4 of our post flood recovery, and will soon be back to normal. THe problem with flooding is that damage can appear several weeks even months down the line.

I still have not received a copy of the signed contract. Neither have I received anything from the DPB about how many patients I am supposed to look after, so the registration of new patients is on hold. The DPB did not even respond to my letters and seem to have forgotten that we exist.They keep paying us though, but they no longer call for our patients to be examined by DRO's. I find this state of affairs quite troublesome.

The PCT have noted that our activity will be WAY down, but have declined to withhold fees as they say that would not be FAIR. I would like to take a moment and say that Chesterfield PCT have proved to be exceptional, efficient and quite frankly outstanding. The news from the rest of the country isn't so encouraging of course. There are several PDS practices in Sheffield (who don't have a written contract)

We had a flood. A pipe went pop and took the whole ceiling down in the downstairs surgery. Whilst we clean up, we are now rather pleased that we have a guaranteed income from a PCT who are reasonable and understanding.

I attended a very Course on PDS in Nottingham yesterday. Al the speakers had very sound advice that NHS dental practitioners NEEDED to hear. Unfortunately there were only about 30 dentists in the bloody room. There should have been hundreds there.

One piece of advice. When you sign your PDS contract (and you should not go into a PDS contract without having the contract signed first) make sure you get a copy of the contract signed by the other party. A contract is not valid until it is signed by both parties. And before you ask, no, I haven't received my copy yet :)

Some dentists, it would seem, give the impression that they are taking the piss. A practitioner who recently entered PDS has gone on holiday..... for a month. His associate would be covering the practice patients, only she is now on maternity leave. The dentist in question has not arranged cover, and is expecting the out of hours service to see to his emergencies. Did someone forget to tell him that the "High Trust Environment" is a two way street. At the very least he should have got a Locum in.

The PCT has contacted the DPB on my behalf and have been told that when practices go into PDS they no longer receive schedules which show the total registrations. I don't know how I am therefore supposed to monitor my patient levels, and I now don't even know whether the list of patients I have from the DPB contains my notional list.

Chesterfield PCT has shown its willingness and ability to help one of their dental practitioners, and I take my hat off to them, especially their dental advisor. The DPB however are playing the same game they have always played, that of being awkward, uncompromising and bureaucratic. It is a shame, because they could have been so much more.

Somebody said something to me the other day that made me think. How much is my practice worth. Well the property alone has doubled in value in the five years since I bought the practice, and is now worth more than what I paid for the whole business. Add to that the fact that my PDS contract value is very attractive, and that most of the equipment in the place is less than 4 years old............ Anybody want to buy a fully systemised practice hahahahaha. Of course, if the price was right, how could I turn it down.

Ok, so I have to admit, it felt quite good being able to go on a week long course, and not have to worry how that would affect next months gross. Apart from a few days at christmas, I haven't had any time off on holiday, and I wonder how that will feel when I do? My first official paid holiday will be in July. PDS is almost a form of passive revenue.... at least initially.

We still haven't had written confirmation of how many patients are on our Notional List. We have been sent a second list, unhelpfully split into four different categories (adults and children times two dentists), but no actual numbers..... and non of the GDS lapsed patients who fall into this 30 month category seem to be on this list. Nobody seems to want to tell me how many patients the PCT want me to treat. As with all bureaucracy, my letters go unanswered.

We have a large pile of undesirables that we will not be treating. There are also a big pile of deregistration forms waiting to be filled in..... if only someone would tell me if these patients are on my notional list. One must remember that patients do actually register at other practices. If someone would only give me a simple figure and a simple list, then I can get rid of the C/D patients in the notional list, and make room for more deserving patients, of which we have a growing waiting list.

I cannot really blame the PCT here, as they are doing the best they can, and are outstanding compared to most in the country. They have a lot to do, and are having to build an entirely new tier to their hierarchy and structure. And as we are still paid and monitored by the DPB, one wonders why my letters go unanswered. I learnt long ago not to bother phoning the DPB, because different people gave different answers.

As expected, the first two months gross income for the practice was very low. There are of course reasons for this:

We have also noticed something else. Treatment patterns seem to come in waves, and we are presently going through our "Healthy, one year recall, quite happy with their mouths" period. I am sure we will soon be going through the "I've broken another tooth" period, and the "my gums hurt and why is my face swollen" period.

We have actually come to the conclusion that about 80% of our patients are stable. Once we have written confirmation of how many patients we are to look after, we can look at taking on some fresh faces. This will let me expand the Oral Hygiene education scheme we are doing, which will mean taking on a new member of staff. But first I want the figures in writing.

Talked to some friends in Sheffield. They have been in PDS for several months now, paid by their PCT. They are still under negotiation on their contract..... meaning they have yet to sign it? I know this is a high trust environment, and I still feel that doing anything without a written contract is a bad idea. And not just for the dentists.

Under the GDS, the prospect of going on a course or going on holiday was always spoilt slightly by the knowledge that it would be accompanied by a drop in income. Many practices found that this adversely affected their cash flow, which is vital for any successful business. One of the major benefits of PDS is that there is a uniform payment every month. Therefore there is no disadvantage with being away from the practice. It will of course affect your treatment profile for that month, but it would be a very foolish PCT that would make an issue of this.......... assuming of course the dentist doesn't take the Michael.

The DPB, who pay us under our PDS are still being awkward with regards to one or two things, like how many patients are actually on our notional list. We have a big list of patients, but no actual figure like the one we received every month under our GDS schedule. I am still waiting for them to get back to me on that one. We would like to take on new patients, as there are some we are looking to de-register (C/D etc). But apart from that, everything seems to be going swimmingly.

Well, we got paid without a hitch which was good. We got a GDS and a PDS schedule, which made me show my teeth a bit. That aspect went well.

We had to badger the DPB to get our Notional list. As you know, we have agreed to look after the last 30 months worth of patients, but we still have the same rights to get rid of patients as we did in the GDS. I have separated all the patients who attended in the last 30 months according to their record card, and am ticking them off against the list provided. Undesirables will be removed, and we are just waiting for the de-registration letter to be approved by the defence agency.

Like many PDS contracts, there is the clause about taking on new patients unless we are at clinical capacity. Having spoken to the PCT, they are quite happy for the practice to decide what constitutes clinical capacity. Still don't have that in writing, but they know that I would convert to private at the first attempt to turn my practice into an access centre.

There is also the question about drop in activity. Our PDS is specifically aimed at prevention, and we have an oral health educator working two sessions a week. A lot of what we are now doing does not have an SDR code, and so we are putting everything in obs. Again the PCT have said not to worry, as we are in a HIGH TRUST ENVIRONMENT. That may be, but I intend to keep the activity very close to the historical contract value. As I have always said, plan for the worse case scenario. We are also recording all our DNA's, late cancellations, clinical governance, holidays, sick days, falling meteorites and practice closure due to alien invaders.

The beauty of PDS is that I am whizzing through the implementation of the last of my systems. Actually, my staff are doing it as their bonus depends on it hahaha. They will soon be knocking off about two systems a week.

There is still a sense of "What are we not doing that we should be, and what surprises are in store".

I cannot help thinking that we are all in for a bit of a surprise. The General Election is close by, and NHS dentists have a great deal of power. Of course this all ends after the election, and the government will be back to their usual ploy of doing whatever they want. I don't believe this is the fault of the government, so much as it is the fault of the population as a whole. Government can only get away with things like this when the people let them........you just have to look at the Ukraine to see that.

A very competent individual rang me from the DPB in response to a letter I wrote them regarding the apparent hiccups we were having. She assured me that everything was set up for us to be paid on time, and we have now even received our Notional list. It is inevitable that some of these patients will be in the C/D category, and I will be spending Monday writing out the first of the De-registration forms. I actually found that only about a third of the "Extra" patients on our notional list were undesirables. Most had simply let themselves lapse, despite our recalls. Whether that's because they don't like the way we deliver our dental care will be seen, but I would like to think that they are just afflicted with the Oral Health apathy that affects 50% of the population.

There are tales of practices who, after converting to PDS, suddenly see their wait for treatment rise to over 3-4 months. There is one practice in Sheffield that now has a 6 month wait. What is the point of that I ask myself? Some have also shown a decrease in the amount of private work undertaken, which sounds completely bonkers. I have already decided that this is not going to happen to my practice.

One slight problem is that we don't know how to monitor what we do. Unlike many PDS practices, we are still funded by the DPB, but the PCT monitor our activity. It would be good therefore for someone to tell us how the OHI and preventive treatment, which do not have the codes on the SDR are to be reported. Also how do we report the practice meetings, the post grad study etc etc. All this takes time away from treating patients, which decreases the perceived contract value. So we are being very careful to keep our activity up until we have a definitive answer to this.

Pawn to Rook 8. That's what it feels like, a game of chess, only the opponent can change the rules at any time :)

The PDS starter kit finally came, or at least part of it did. We are still waiting for

Also I boobed big style. I didn't read the contract carefully enough, and now have to deal with this choice. I knew that I would have a Notional list of the last 30 months patients, but didn't pay attention as to HOW I could remove patients from that list. The PCT demands I use the official de-registration forms. OK, that's fine, and someone at the PCT is going to be VERY busy processing them, because there are around 200 patients that I am not willing to accept back.

Still no sign of a change to the October contract. There is no way I am signing up to that, so I will be contacting Practice plan for a second interview in the new year. As I always say, you have to be prepared for the worse case scenario. That is one of the reasons I went into PDS. I wanted to see just how bureaucratic things would become, whilst receiving a set income that would allow me to do the final changes to my practice. I originally intended to go into the new contract, but that was of course before I read it. As it stands, it is completely unacceptable.

Well, despite the fact that we got all the forms in on time, we still have yet to receive the PDS starter kit from the DPB ......which is rather important because without this we won't get paid next month. We have the new contract numbers, but only one stamp has arrived. There is a certain amount of "the left hand not knowing what the right hand is doing", and the minions at the DPB don't really seem to know what they are doing. This is not particularly encouraging.

Unlike many of my friends in Sheffield (remember I work in Chesterfield) i actually have a written contract that I am working to. We went live on the 13th of December, and found the PCT to be very helpful. We are still being paid by the DPB, which was supposed to simplify things. We shall see.

The plan was to enter into a PDS contract that would allow me to do in depth oral hygiene education, along with a mechanism for grading patients according to presenting risk factors. The PCT was very helpful in this regard, and say they will allow for a 15% drop in activity.

The first challenge we encountered was the delay from the DOH. They were very slow. The second challenge was the contract offered was completely unacceptable and could only be accepted with major revisions. We waited another month for the DOH and the PCT to reply, only to be told that this contract was no longer the one they wanted to use. Instead they presented one which was basically the present GDS contract. THe only difference was a 30 month clause. This was not a problem to me, as I have been selectively purging all the patients I do not want for the last 4 years. Any remaining can simply be "de registered" in the same way as before. All the patients who are not to be asked back have read tags on their notes, and the staff are presently going through these to make sure non are eligible for treatment under the new contract.

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