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.

October 20th

Advice from Challenge:

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.

Many PCTs appear ignorant of or just ignore the correct procedure.

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.

Please do not hand back cash without question.

Contract sanctions and the NHS dispute resolution procedure for nGDS:

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

348.2. the Contractor ceases to pursue the NHS dispute resolution
procedure,

whichever is the sooner.

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-

350.1.1. protect the safety of the Contractor's patients; or

350.1.2. protect itself from material financial loss,

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

October 15th

New Inquiry Dental Services Terms of reference

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:

. The role of PCTs in commissioning dental services;

. 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 work of allied professions;

. Patients' access to NHS dental care;

. The quality of care provided to patients;

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

. Dentists' workloads and incomes; and

. The recruitment and retention of NHS dental practitioners.

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.

FURTHER INFORMATION:

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].

2. More information on the Committee's inquiry can be found on the
Committee website at:
www.publications.parliament.uk/pa/cm200405/cmselect/cmdfence/45/4502.htm

Committee Website: www.parliament.uk/healthcom/

October 9th

BDA Press release

*Why is dentistry the poor relation in the NHS, asks the BDA? *

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.

Peter Ward, Chief Executive of the BDA, said:

"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. ”

September 12th

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.

September 6th

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

Dear Lester

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

August 23rd

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.”

August 7th

http://newsvote.bbc.co.uk/1/hi/health/6935139.stm

"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."

August 5th

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 :)

June 24th

£22m dental Welsh underspend scandal

http://tinyurl.com/2v5kzu

June 20th

here are the latest statisitcs on NHS dentistry

http://www.ic.nhs.uk/news-and-media/press-releases/june-2007/latest-statistics-on-adults-and-children-seen-by-an-nhs-dentist

http://www.ic.nhs.uk/pubs/dentalq4

Enjoy :)

June 7th

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!!!!!!!!!

June 6th

A lovely story in the Daily Mail.

http://www.dailymail.co.uk/pages/live/articles/health/

healthmain.html?in_article_id=459795&in_page_id=1770&ito=1490

They did of course fail to answer 4 very important questions:

YEAH? AND? SO? WHAT?

June 5th

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.

June 4th

The latest Birmingham LDC newsletter

http://www.birminghamldc.com/files/docs/newsletter.pdf

June 1st

Taxpayers money well spent

http://www.gazette-news.co.uk/display.var.1440587.0.0.php

NOT!

May 29th

New guidance for PCT's on handling contract breaches

http://www.pcc.nhs.uk/uploads/Dentistry/may_07/

handling_contract_breaches.pdf

May 28th

More newspaper wafflings today.

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

http://business.timesonline.co.uk/tol/business/industry_sectors

/health/article1848325.ece

And we have the Telegraph following the lead of the Times -

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/05/28/nhs28.xml

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.

May 27th

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

http://www.timesonline.co.uk/tol/life_and_style/health

/article1845202.ece

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

May 26th

Heres a good one form Hansard

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.

May 25th

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.

Has anyone from the BDA actually read "The Art of War"?

May 20th

The Department of Health in England has today published guidance to PCTs on single-use instruments for endodontic procedures: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/

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"

May 19th

The CDO speaks

"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."

Ahhhh, I feel so much better now.

May 18th

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.

May 17th

Prions again.

http://www.which.co.uk/files/application/pdf/February%202007-445-111827.pdf

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.

May 16th

Back from holiday, so let's kick off with:

BDA support helps win judicial review

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.”

May 1st

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.

Funny how I don't sound surprised isn't it.

April 30th

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

http://www.dailymail.co.uk/pages/live/articles/health/

healthmain.html?in_article_id=451598&in_page_id=1774

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

Then we have the Times:

http://www.timesonline.co.uk/tol/news/uk/health/article1723224.ece

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

bidding for further low cost UDA's
Changing the way we work to maximise the system
Sitting on our hands and hoping for the best
Arguing with each other how ethical differant UDA milking techniques we can use.

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.

As the old Chinese curse says - "may you live in interesting times"

April 29th

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

http://www.medicalnewstoday.com/medicalnews.php?newsid=69143

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).

April 28th

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).

Hence the following:

CHALLENGE FUNDING APPEAL

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.

Please SUPPORT us, so that the fight can continue on your behalf.

Cheques should be made payable to CHALLENGE –

And sent to 20 Ramshill Road, ScarboroughYO11 2QE

Transfers can be made to

Royal Bank of Scotland19 Huntriss Row, Scarborough YO11 2ED

code 16-31-14, a/c no. 10130551

April 27th

Challenge w ish to invite you to a one day Summit

Hilton Metropole Hotel

Birmingham June 7th

Are you, like us

Fed up of hearing excuses why the Dental Industry should not make waves about the new NHS contracts?
Thinking UDAs will cause untold damage to dental practices and those whose livelihoods depend on them?
Angry how patients and businesses are suffering as a direct result of the lack of consultation and lack of proper guidance to PCTs and practices?
Concerned about the de-skilling effects of UDAs on the profession?

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.

If you have been affected by the new contracts

If your members or colleagues have been damaged by the fallout

If you feel aggrieved by what has happened

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.

It’s time to stand and fight or hand them victory on a plate

It’s time to choose!

Challenge would like you to be there for this historic Summit

Email your response now to:

ChallengeDoH@aol.com

April 21st

From: PETER WARD BDA Chief Executive

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.

April 20th

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.

April 18th

From the BDA website - my comments, as usual, in green.

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

April 16th

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

April 15th

Revised Statement of Financial Entitlement - April 2007

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.

April 14th

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.

April 13th

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.

April 12th

From the HSJ

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.

April 11th

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.

April 10th

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.

April 9th

Happy chocolate rabbit day

April 5th

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.

Here are the headlines –

The new contracts were introduced to improve access to NHS dentistry but only 1 in 5 dentists is taking new NHS patients
4 out of 5 dentists have to restrict access to NHS treatment in some way
99.8% of dentists say the new contract has done nothing to improve their working lives
80% say there is no new treatment capacity available in their area
Half of all dentists are struggling to meet their NHS output targets and face financial penalties as a result
85% of dentists think the service is in trouble or in terminal decline in their area
40% of dentists would like to leave the NHS and the new contract has made the problems worse
97% of dentists do not agree with a series of statements made by the Chief Dental Officer for England

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.

The ‘Challenge’ website can be found at – www.ChallengeDoH.com

April 4th

The BDA SPEAKS...................... my, just think of the consequences :)

----------------------------------------------

*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.

But don't forget, it's a mans life in the BDA

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.

April 3rd

It looks like the data gathering abilities of the old DPB are being missed.

-----------------------------------------------------

From: Dr Barry Cockcroft

Chief Dental Officer for England

To: PCT Chief Executives GATEWAY NO. 8096

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

2 April 2007

Dear Chief Executive,

NHS Dental Survey Programme

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,

Barry Cockcroft
Chief Dental Officer (England)

April 2nd

Not a bad article for the BBC -

http://news.bbc.co.uk/1/hi/health/6496507.stm

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

April 1st

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?"

Anyway, if you want to claim back yourNon Domestic Rates, or whatever, here is the link - http://www.dpb.nhs.uk/archives/documents/APP%20for%20SFE%2027-03-2006.pdf

March 26th

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 ;)

March 25th

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

http://www.yorkpress.co.uk/news/yorknews/display.var.1278308.0.tooth

_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."

March 24th

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.

At the very least, start you departure now.

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.”

For a copy of the third quarterly report on dental statistics in
England please see: http://www.ic.nhs.uk/pubs/dental06q3

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

March 23rd

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:

"Dear All

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 th