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Overview and Scrutiny Committee Herts 2007

Overview and Scrutiny Committee Herts 2007. The New Dental Contract 12 months on Sue Gregory Consultant in Dental Public Health. Primary Dental Services (2003 Act). PCT has a duty to provide or secure primary dental services to the extent it considers reasonable through: GDS contracts;

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Overview and Scrutiny Committee Herts 2007

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  1. Overview and Scrutiny CommitteeHerts 2007 The New Dental Contract 12 months on Sue Gregory Consultant in Dental Public Health

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

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

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

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

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

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

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

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

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

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

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

  13. Local variation of need Local flexibility Development of Commissioning (rather than contracting) Post 2006 • PCTs will move from historically based contracting to commissioning locally sensitive services

  14. PCT UDA delivery UDA deficit PCR deficit 1 93.5% 36,033 £549,324 2 96.6% 9,303 £243,203 3 91.8% 71,073 £1,605,675 4 89.5% 72,627 £532,452 April 2007 outturn for 06/07- PCTs (incomplete data)

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

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

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

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

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

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

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

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

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