What impact will The NHS target increase have on UK dental practices?

We have fortuitously entered into the third year of the COVID-19 pandemic and we should probably have anticipated that the virus would defy all predictions. Because it did. With the raging tsunami of the Omicron coming in like greased lightning, we are quickly facing a situation beyond repair.

With the drastic change in the immunological landscape and the subsequent upheaval in systems of healthcare, the virus has applied enormous strain on the country’s economy and spirit. In the midst of this traumatic affliction, the NHS has divulged some information that can only be described as cynical, tongue-in-cheek humour.

There were talks in the grapevine for months on end about reforms to be announced shortly but as we approached the final quarter of 2021 and still no news had been reinforced, worries and frustrations dissolved in the wake of the New Year’s celebrations.

However, as the inherent itch for indigenous chaos and institutionalised mayhem would have it, the NHS imposed an 85% activity target increase for dental practices across the country within just minutes to spare and even before the relaxation of COVID restrictions on the last week of December 2021.

This is a huge dump of information, so let’s start from the basics.

What is a UDA?

Units of Dental Activity (UDAs) have been a contentious subject ever since their initiation as a part of the 2006 NHS dental contract. They were brought to life in order to measure a practice’s activity and in turn to ensure that the correct amount of patients’ charges was collected.

Obviously, this did not go very well with the dental casualties due to the pressures of being unable to fulfil the levels expected from them. Following this dangerous slope, at the end of 2019, NHS England declared reforms in regulations to be rolled out nationally in April of 2020.

One of the key policy changes was the expectations of a new blended remuneration system. In essence, the UDA reform stated that if a practice achieves less than 96% of its contractual obligation, it would be subject to clawback. A clawback refers to a process where the authority who provided the practice with the contract would be legally permitted to claim back the value of their unachieved units.

What were the target changes?

Today’s topic of discussion revolves heavily on the financial dependency of the NHS, intermixed with a divergent level of communal disregard. It has been within the government’s ballpark to be able to predict the economic cognition in the near future especially in the wake of the Omicron virus and yet they have gone along with the decision to increase the dental target to 85% effective January 1, 2022.

Chief dental officer Sara Hurley announced that NHS targets will increase to 85% from January. And starting April 2022, this target is to increase to 100% when practices are asked to revert to their usual contract management arrangements.  This means that dental practices will be obliged to meet 85% of their pre-pandemic activity levels. This target is upped to 90% for orthodontic contracts. Any practice failing to meet these targets will face steep financial penalties.

The Department of Health says NHS England is working closely with the profession on “the recovery of dental services” to enable more patients to be seen. As a measure of application, they have set dental surgeries a target based on what can safely be achieved using data on dental activity achieved to date.

A Department of Health and Social Care spokesperson said:

“We have taken unprecedented action to support NHS dentists throughout the pandemic by providing full income protection for practices unable to deliver their usual level of activity.

“The targets set are based on what can safely be achieved, as well as data on dental activity achieved to date.

“An exceptions process will continue to provide a safety net for practices who are unable to deliver at the threshold for income protection, due to extenuating circumstances.”

What was the reaction from the masses?

Ever since the chief dental officer announced the new target obligations, the subject has attracted consistent and widespread criticism and the overall reaction from the profession has been of profound shock and dismay.

According to the NHS, they are reinstating protocols to measure dental capacity in the making by catching up on backlogs and eliminating gratuitous behaviour. But this seemingly noble sentiment has not been shared by much of the dental industry.

In fact, most dental professionals are currently accusing the NHS of purposefully bulldozing an entire community of hard-working dentists. Essentially, this could be their way of deep cleaning the system and “incompetent” workforce. Nearly two-thirds of practices currently estimate that they are incapable of achieving these sky-high levels since practices are already reporting a major spike in appointment cancellations and staff sickness.

The British Dental Association has also condemned the government’s decision to impose “unrealistic” activity targets on the NHS-signed dentists and staff during the risky Omicron wave. The BDA has also underlined this approach to be wholly at odds with the comments from the Prime Minister when he stressed “we want the NHS to be a better place for the dental profession.”

In conjunction with the cavalier attitude of the NHS, the BDA has warned the government that this banal decision could potentially cause a massive exodus of dentists from the already depleting dental workforce in the NHS.

How would this impact the dental industry?

The target hike decisions made by the NHS has been publicly dissected and lampooned by dental practitioners who are well-aware of their irresponsible and unrealistic expectations. This constricting reform has caused an uproar and has been expected to cause some major long-term impacts on the dental industry as a whole.

Unwillingness to open

Whilst several pandemic restrictions in dental settings have been eased in the recent past, the BDA reports that nearly a third of the dentists (33%) have no intentions to relax COVID precautions in their respective clinical settings. The Omicron variant has also had a huge impact on almost half of the dentist’s willingness to change tack in the midst of this savagery.

Up until now, certain protocols were imposed on dentists. The dental practitioners were expected to maintain gaps of up to an hour between appointments in order to reduce the risk of viral transmission. Now that these restrictions have been relaxed, most dental offices continue to maintain their composure to avoid putting both patients and staff at unnecessary risk. Due to this, there has been a radically reduced number of patients walking into clinics.

Shawn Charlwood, chair of the BDA’s General Dental Practice Committee concured with this point of view and stated,

“The country faces a tidal wave of infection. Dentists are understandably nervous about easing restrictions, and patients are already cancelling in droves.

“This policy might suit the Treasury, but will put patients, staff, and the very sustainability of NHS dentistry at risk.”

Failure to meet expectations

In November 2021, it was reported that the mean performance was 75% of contracted monthly UDA activity. Due to biased and incomplete reviews like such, the NHS demands a peak performance record from all of its dental staff this year.

However, what most dental professionals report is that the 65% targets were already demanding to reach. This also acts as a coadjuvant to the point made above whereby keeping patients safely socially distanced in a relatively small waiting room can become challenging. It is simply impossible to be able to meet the target of 85% without compromising the safety protocols and health of the patients and the staff.

Patient care will suffer

One of the most devastating impacts of a target-based system is that it can easily undermine patient care. The need for meeting targets will cause dentists to shift their focus from the heavy backlogs of priority urgent cases to undertaking a large volume of routine checkups. This is because performing time-consuming urgent treatment puts the practice in danger of seeing only a small sample of patients per day.

This move from the government will not benefit the patients who are in dire need of treatment and dental visits and as a result, those dentists who want to do the right thing for their patients will be punished for it. In order for these dentists to stay financially afloat, they will need to choose between low-risk cases and people in pain. Therefore, it creates an incompatible environment for providing safe and sustainable services to the patients.

Dentists leaving the NHS

The enormous amount of pressure put on the dentists will ultimately result in them exiting the profession altogether. The BDA has stated that there are currently 28,000 General Dental Practitioners and nearly 47,000 registered dental nurses working in high street practice in England. Just last year, about 1000 dentists left the NHS.

Additionally, a recent BDA survey suggests that:

  • Over 40% of NHS dentists claim to be likely to change careers or seek early retirement in the year due to these new target pressures.
  • More than half state that they are likely to reduce their NHS commitment.
  • 1 in 10 estimate their practices will close in the next 12 months.

Closing statement

The innocuous attempt of the NHS to raise effort and stabilise career satisfaction in the industry has backfired greatly. Instead, now we are met with a devastating lapse in morale and financial insufficiency in the service. Most dental professionals expect to not meet the 85% thresholds and are worried to be given the boot in the current year. This misplaced rationale from the NHS may be the straw that finally breaks the camel’s back. Only time will tell.