NHS

SNOMED disruption: urgent statement now required

The British Dental Association has urged NHSX and the Office of the Chief Dental Officer to issue an urgent statement on the status of SNOMED CT, following updates instructing practices to implement the system from 1 September 2021.

SNOMED aims to ensure better interoperability between health services for patients, by ensuring clinical notes are coded in a standardised way. The planned implementation was postponed from 1 April 2021. The BDA had previously expressed grave concerns that the systems in place for its use in dental practices are not sufficiently robust at present to ensure patient safety and a smooth rollout that would not impact on time spent with patients.  

The recent announcement came as a surprise to GDPs and many major software suppliers. 

Shawn Charlwood, Chair of the BDA General Dental Practice Committee, said: “Since March, we have been engaging with NHSX, as advised by the Minister Jo Churchill, to resolve the outstanding issues with implementation of SNOMED CT. In our meetings, NHSX has been clear that it did not regard it as necessary for dental practices to implement SNOMED from 1 September 2021 and that instead it wished to take the time to work with BDA to develop a subset of dental-specific SNOMED codes that would be appropriate for use.

“It was therefore unexpected that NHS England and the Office of the Chief Dental Officer announced on 31 August that practices were expected to begin using SNOMED from 1 September.

“As a result, we sought urgent clarification from NHSX, as the NHS body responsible for SNOMED, as to what practices were required to do and we demanded a joint statement from NHSX and the OCDO today to clarify matters. It is disappointing that there have been conflicting views from the two organisations.

“The BDA has been engaging with various NHS bodies including NHS England, the Office of the Chief Dental Officer, the NHS BSA and NHSX since it was announced in 2016 that storage of records using SNOMED CT would become a requirement.

“Our objective throughout this was to ensure that there was clear information about what implementation would entail and that the process for doing so would not disrupt practices’ operation. It is regrettable that, despite our efforts, the various NHS bodies have not provided dentists, their practices, and software suppliers with the clarity needed to implement SNOMED without such disruption. We will continue to press for an urgent statement from NHSX and the OCDO.”

BDA reacts to NHS Dental earnings data: ‘Lost decade undermining NHS dentistry’s Covid recovery’

‘A historic collapse in dentists’ earnings across the UK is jeopardising the long term recovery of the service from the Covid pandemic,’ says the British Dental Association.

BDA analysis of new official figures on earnings and expense levels in NHS dental practice show high street dentists in England have seen taxable income fall by nearly 40% in real terms over the last decade. The story is replicated across the UK nations, with real terms falls in Wales, Scotland and Northern Ireland of well over a third since 2009.

The new 2019/20 figures capture the period just before the first lockdown. Above-inflation uplifts have remained the exception rather than the rule since the financial crash, with across-the-board cuts in pay in both cash and real terms.

Unlike their medical colleagues NHS dentists do not typically receive any capital investment from central government, with profits funding all improvements in equipment, training, and facilities for NHS practices. While devolved governments have provided millions to invest in new ventilation systems, to help increase patient numbers while maintaining strict infection prevention control measures, there have been no parallel commitments from Westminster. Practices are also facing mounting costs for clinical waste and essential equipment, without comprehensive support.

The BDA has warned continued pay restraint will only accelerate the drift away from NHS dentistry. Recent surveys have indicated nearly half (47%) of dentists in England indicate they are now likely to change career or seek early retirement in the next 12 months should current Covid restrictions remain in place. The same proportion state they are likely to reduce their NHS commitment.

The historic driver of low morale in the sector remains the discredited target-based NHS dental contract imposed on the profession in 2006, which has proved incompatible with providing care during the pandemic.

Prior to Covid, unmet need for NHS dental services was already estimated at over 4 million, or 1 in 10 of the adult population. Over 30 million NHS appointments have been lost since the first lockdown in England alone.

Shawn Charlwood, the BDA’s Chair of the BDA’s General Dental Practice Committee said: “This lost decade on pay will inevitably undermine NHS dentistry’s recovery. Government has taken the ‘do more with less’ mantra to the nth degree. Every penny of investment in this service comes from dentists’ own pockets. This historic squeeze has left practices unable to deliver needed improvements in facilities, equipment, and training, even before the added costs of Covid arrived.

“The pandemic has exposed the rotten foundations this service is built on, with failed systems and underinvestment leaving millions unable to secure the care they need. Dentists need to see this service as a place they’d chose to build a career. From discredited contracts to flat lining pay, no one should be penalised for working in the NHS.”

General Dental Service/Primary Dental Service taxable incomes, nominal and real 2008-2020, for Associate dentists and Owners. Cash figures from Dental Earnings and Expenses Estimates 2019/20, 19 Aug 2021. Real terms calculations by British Dental Association deflated by the Retail Price Index.

      2008/09 2019/20 % fall 2008/09-2019/20
England Associate Dentists Cash terms £67,800 £58,100 14%
    Real terms £67,800 £42,942 37%
  Practice Owners Cash terms £131,500 £112,600 14%
    Real terms £131,500 £82,223 37%
Wales Associate Dentists Cash terms £66,500 £61,900 7%
    Real terms £66,500 £45,750 31%
  Practice Owners Cash terms £122,400 £98,900 19%
    Real terms £122,400 £73,097 40%
Scotland Associate Dentists Cash terms £67,100 £58,300 13%
    Real terms £67,100 £43,089 36%
  Practice Owners Cash terms £118,700 £103,700 13%
    Real terms £118,700 £76,645 35%
Northern Ireland Associate Dentists Cash terms £66,700 £57,200 14%
    Real terms £66,700 £42,276 37%
  Practice Owners Cash terms £129,600 £99,200 23%
    Real terms £129,600 £73,319 43%

Dental and GP earnings data published by NHS Digital

Annual statistics on the earnings and expenses of GPs and dentists have been published today by NHS Digital.

Dental Earnings and Expenses Estimates 2019/20 provides a detailed study of the earnings and expenses of self-employed full-time and part-time primary care dentists who carried out some NHS/Health Service work during that financial year.

Figures are reported separately for each of England, Wales, Scotland and Northern Ireland.

Meanwhile, the GP Earnings and Expenses Estimates 2019/20 reports on full and part-time GPs working in the UK as either a contractor or salaried GP during the 2019/20 financial year under a General Medical Services (GMS) or Personal Medical Services (PMS) contract. This report covers both their NHS and private income. The report publishes data from across England, Wales, Scotland and Northern Ireland.

As per NHS Digital, ‘Dental Earnings and Expenses Estimates, 2019/20, provides a detailed study of the earnings and expenses of self-employed primary care dentists who undertook some NHS/Health Service work during the financial year. Figures relate to both NHS/Health Service and private dentistry and are shown for full-time and part-time dentists; some analysis by weekly working hours bandings are included using information from the biennial Dental Working Patterns Survey (and are included in the interactive report). Although the report contains analysis for England, Wales, Northern Ireland and Scotland, the values are not directly comparable between countries; this is due to differing contractual arrangements as well as the use of different methods to derive dental type in each country.

‘The analyses throughout this report are based on anonymised tax data for dentists with accounting periods ending in the fourth quarter of 2019/20 and effective as of the end of March 2020. The tax data cover self-employed dental income from all sources, including from private dental practice. Data on earnings from employment or for those dentists in private practice only are not included.

‘The report is primarily used as evidence in remuneration negotiations and by the Review Body for Doctors’ and Dentists’ Remuneration. It has been produced by NHS Digital in consultation with the Dental Working Group which includes representatives from the Department of Health and Social Care, NHS England and NHS Improvement, Welsh Government, Department of Health Northern Ireland, the Northern Ireland Health and Social Care Business Services Organisation, Scottish Government, NHS National Services Scotland: Information Services Division, NHS Business Services Authority Information Services, HMRC: Knowledge, Analysis and Intelligence Division, the National Association of Specialist Dental Accountants and Lawyers and the British Dental Association representing the views and interests of dentists.

‘The first cases of Covid-19 in the UK were confirmed late January 2020 and the first UK-wide lockdown was announced on 23 March. This was followed by an announcement from the chief dental officer for England on 25 March 2020 of the temporary suspension of all routine dentistry and many dental practices were able to offer little or no NHS treatment for some or much of the 2020/21 financial year. However, given the timing of the introduction of emergency lockdown measures, we have little evidence that the earnings and expenses estimates of NHS/Health Service primary care dentists were greatly affected by the Covid-19 pandemic during the 2019/20 financial year.

Amanda Pritchard appointed Chief Executive Officer for NHS England

Amanda Pritchard will be the first woman in the history of the National Health Service to hold the post of Chief Executive Officer (CEO) for NHS England, which she will take up on Sunday 1st August after serving as the Chief Operating Officer (COO) for two years.

Pritchard’s appointment follows an open and competitive recruitment process by the Board of NHS England and NHS Improvement. According to the NHS website, she will be responsible for an annual budget of more than £130 billion while ensuring that everyone in the country receives high quality care.

“I am honoured to lead the NHS, particularly as the first woman chief executive of an organisation whose staff are more than three quarters female,” said Pritchard. “I have always been incredibly proud to work in the health service but never more so than over the last 18 months as nurses, doctors, therapists, paramedics, pharmacists, porters, cleaners and other staff have responded so magnificently to the Covid pandemic.

“There are big challenges ahead as NHS staff continue to deal with significant pressures while maintaining the roll-out of the hugely successful NHS vaccination programme and tackle backlogs that have inevitably built up in the face of rising Covid infections. However the skill, determination and ‘can do’ spirit that NHS staff have shown in the face of the greatest challenge in the health service’s history means we face the future with confidence.”

What might this mean for dentistry?

Although Amanda Pritchard has not had the chance to discuss dentistry since the announcement of her new appointment, GDPUK reports that, in 2020, she stood to bat for the profession by providing oral evidence to the parliamentary Health and Social Care Committee on the ‘Delivery of Core NHS and Care Services during the pandemic and beyond’.

At that time, Pritchard is on the record as saying: “Dentistry is a hugely important service. We are very much aware that the whole of the dental sector has, as has the rest of the NHS, stepped up through the Covid crisis despite considerable pressures on their services. Our particular responsibility is to NHS dental practitioners. What we have done is maintain a roll-over contract model from last year, so that there is stability and a reliable source of income that is separated from the amount of activity that is being done at the moment. Exactly as you say, in common with the rest of the NHS, there are real constraints around the productivity that dental services are able to operate. At the moment, balancing safety and patient needs, we absolutely support dentists making some local judgments about what the right balance is to make sure they are able to operate safely.

“From an NHS perspective, we are working closely with the BDA around things like PPE costs. We are conscious, as has been mentioned, that both the demand for PPE and the price of PPE has risen, so we are very keen to continue working with the BDA to make sure that we support NHS dentists through that.”

Time will tell as to whether the CEO of NHS England can help to bring some reform to NHS dentistry in the country.

BDA: ‘Long-term approach to pay is now required to keep NHS dentistry viable’

The British Dental Association (BDA) has said a long-term approach to pay is now required to keep NHS dentistry viable, following confirmation of a 3% pay award.

The pay award meets the recommendations made in the 49th report of the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) in full, and marks the third consecutive above-inflation increase following a decade of pay restraint, which saw real incomes for practitioners fall by over 35%.

The pandemic has added to long-term pressures facing general dental services across the UK. Recent surveys indicate nearly half (47%) of dentists in England are now likely to reduce their NHS commitment, should current restrictions remain in place, with the same proportion indicating they will seek early retirement or a change in career.

With inflation now at 2.5%, the BDA has stressed an ongoing commitment to fair pay is required to guarantee the long-term sustainability of the service, alongside parallel action on a roadmap to ease pandemic restrictions, and meaningful reform of the contractual systems NHS dentistry operates to. The discredited activity based systems in operation across the UK have fueled recruitment and retention problems and have proved unworkable since lockdown.

The announcement will see the 3% uplift on pay backdated to April, with no staging. This will apply to community dentists in full, with a final uplift to contract values for general dental practitioners to be confirmed following consultations on expenses in the four UK nations. Consultants will see a 3% uplift in basic pay (Specialty and Associate Specialists (SAS) and Juniors have separately agreed pay deals). The BDA has encouraged practice owners to engage with their associate dentists to discuss their contractual arrangements in light of the uplift.

BDA Deputy Chair Peter Crooks said: “An uplift on the right side of inflation is progress. A decade of pay restraint has taken its toll, and we can never return to recommendations that fail to reflect the cost of living.

“Both providers and performers need to see the benefit of this uplift. This has been a hard year for practices, but we look to owners to ensure this increase reaches their associates. Even before Covid, a growing number of colleagues saw no future in the NHS. If we’re ever going to make this service a going concern then fair pay must remain the rule.”

NHS Dentistry: No turning back to broken system in Wales

The British Dental Association Cymru has lauded the statement today from Baroness Morgan, which indicates there will be no return to the ‘failed system’ NHS dentistry operated to prior to Covid.

The widely discredited target-based contract for high street dentistry, in operation since 2006, was effectively suspended at the onset of lockdown. It capped patient numbers, failed to reward preventive work, and fuelled both access problems and a collapse in morale among the profession.

The Minister has pledged to ensure that all the gains experienced within the variation to the General Dental Services contract will be preserved as Wales moves out of the pandemic recovery of NHS dentistry.  

An evolutionary approach to reform has been working well under the leadership of the Chief Dental Officer Dr Colette Bridgman, and the BDA sees this partnership with dental branch continuing as it heads towards the next phase of contract reform in April 2022.  

Dr Bridgman retires this month, and she has ensured that continuity plans are in place until her successor is appointed. The BDA has stressed its commitment to work with the new CDO to ensure that the profession is fully consulted every step of the way towards a reformed NHS contract that works for the profession and patients.

Access to NHS dental services faced crisis prior to the pandemic. Back in 2012, 37% of practices in Wales were accepting new NHS patients, but by 2019 fewer than 16% were able to take on new adults. 

Russell Gidney, Chair of the BDA’s Welsh General Dental Practice Committee, said: “This is welcome news for families across Wales. It means there will be no turning back to a failed system that put government targets ahead of patient care. In Wales at least we are assured that the mantra of build back better is actually being applied to our health services.” 

Local dental committees call on government to tackle dental crisis

Local dental committees (LDCs) are warning that the survival of NHS dentistry is at risk. Their second online annual conference takes place on Saturday 12 June, and dentists will be looking for answers. Key speakers at the conference will be Ed Waller – director for primary care strategy and NHS contracts at NHS England and Improvement – and England’s chief dental officer, Sara Hurley. 

LDCs want to know how the government and respective NHS bodies are going to tackle the recruitment and retention crisis as a damning report from Healthwatch England reveals that some dental patients within the NHS are being put on a three-year waiting list.  At the same time,  a BDA survey reveals that nearly half of dentists are likely to change career or seek early retirement in the next 12 months if the current Covid restrictions remain in place.  

Motions at the conference will also raise a plethora of workforce issues that are crucial to delivering NHS dentistry.  These range from seeking clarity on the admission of new EEA graduates onto the GDC list of registrants to a call for urgent action by the government and commissioning bodies to tackle the additional recruitment challenges faced by rural communities and those far from dental schools.

Conference will hear that dentists are exhausted from having to wear enhanced personal protective equipment and will be wondering if this is still necessary as lockdown restrictions ease, and as an evolving evidence base calls this into question.  A motion will say that this adds to the strain of working for a relentless target-driven NHS system that demands back-to-back aerosol generating procedures.

LDCs will iterate support for the development of properly funded robust and effective programmes to support the delivery of oral health services to the homeless and socially marginalised groups in society.  In keeping with this, a motion will be urging policy makers to develop programme frameworks that enable sustainable care for these groups. These are just a few of the topical issues, among the anticipated 32 motions, that will be aired at conference.

In a shift of gear, guest speaker Steve Mulligan, GDP, clinical tutor, will share some of his insights into sustainable dentistry. Steve will draw from his experience as a GDP at the coal face, and his research at Sheffield University into the emerging challenges of single use waste and dental material-based environmental issues.

Shawn Charlwood, Chair of the BDA’s General Dental Practice Committee said: “Just about everyone – dentists, MPs and Healthwatch England – are calling on the government to take action over the dental care crisis which has worsened throughout the pandemic.

“It’s unacceptable that patients are being told they have to wait for years before they can be treated. We need a well-trained, highly motivated workforce to deliver this care but the government is driving dentists away from the NHS in their droves.

“After a decade tinkering around the edges a contract that isn’t fit for purpose, we need reform that offers dentists a supportive environment where they actually want to work. And it needs to be in place by April.

“If NHS dentistry is to survive in more than name, the government has to grasp the nettle and invest in dentistry now.”

Chair of this year’s LDC conference, Stuart Allan, said: “Once again the LDC annual conference will drive home what we know already – that the long-term sustainability of NHS dentistry is in question.  A chief executive from Healthwatch who was recently interviewed on the BBC said the government must heed the dental professionals and patients because they have the answers to fixing a broken system.  We’ll certainly have some of those at our conference.  We hope the government is listening?”

NHS England informs dental practices of contractual arrangements over next six months

NHS England has, today, informed dental practices of the contractual arrangements over the next six months in a letter from Ian Dodge, Executive Director of Primary Care, Community Services and Strategy, and Jo Churchill, Parliamentary Under Secretary of State Prevention, Public Health, and Primary Care.

An electronic copy of this letter, and all other relevant guidance from NHS England and NHS Improvement can be found online here.

The letter, which can be read in full here, states that, ‘in December 2020, following discussion with the Department of Health and Social Care (DHSC) and NHS England, the return to usual pre-pandemic NHS contract arrangements was confirmed, ending income protection as rapidly as proves practicable.’

However, it also states that DHSC and NHS England are  mindful that:

  1. current IPC arrangements will continue to act as a brake on full recovery
  2. practices want as much stability as possible, and the ability to plan ahead; and
  3. the profession seeks faster progress on reform of the current UDA contract.

In addition, DHSC has asked NHS England to lead the next stage of dental contract reform, working with the BDA and government to develop a revised reform process focused on designing implementable proposals that ‘address the key challenges facing the delivery of NHS dentistry, leverage changes in the wider primary care system and meet the key tests described below’. DHSC will work to gain cross government agreement to any proposals and expedite any necessary legislative change that is required as part of this necessary reform process. 

It is noted that for national contract reform to be viable, six aims apply. They are that contract changes must:

  1. Be designed with the support of the profession
  2. Improve oral health outcomes (or, where sufficient data are not yet available, credibly be on track to do so)
  3. Increase incentives to undertake preventive dentistry, prioritise evidence-based care for patients with the most needs and reduce incentives to deliver care that is of low clinical value
  4. Improve patient access to NHS care, with a specific focus on addressing inequalities, particularly deprivation and ethnicity
  5. Demonstrate that patients are not having to pay privately for dental care that was previously commissioned NHS dental care
  6. Be affordable within NHS resources made available by Government, including taking account of dental charge income.

The letter also states that, in February, mean performance was 59% of contracted Units of Dental Activity (UDAs) and that contracts will continue to be in place for 100% of normal volumes, and ‘our
expectation is that all NHS funded capacity is used to deliver the maximum possible volume of safe care for patients. In recognition of the ongoing constraints to practice capacity due to Covid-19 there will be ongoing contractual protection for practices unable to deliver normal contracted activity for the first six months of 2021/22. During this period clawback will not be applied to practices delivering at least 60%1 of contracted UDAs and 80%2 of contracted UOAs (Units of Orthodontic Activity). The rate of clawback will then reduce linearly down to the existing lower threshold of 36% UDAs and 56% UOAs. Below these levels normal clawback will apply. The payment for activity not delivered, exempt from clawback by these arrangements, will continue to be adjusted by 16.75% to take account of variable costs not incurred.’

Read the letter in full here.

The latest NHS dentistry and oral health bulletin update from Sara Hurley and Gabi Darby, meanwhile, focuses on the next steps for dental contract reform.

New figures show ‘’collapse in children’s dental visits as a consequence of the pandemic”

The Association of Dental Groups has responded to this morning’s publication of the latest NHS Dental Statistics Biannual report for England 2020-2021.

The statistics reveal that overall, 3.6 million children were seen by an NHS dentist in the 12 months up to 31st December 2020, which equates to 29.8% of the child population.

This compares to 7 million children seen by an NHS dentist in the 12 months up to 31st December 2019, which was 58.4% of the child population in the previous report demonstrating the dramatic effect of the pandemic on oral healthcare for children during 2020.

Neil Carmichael, Chair of the ADG, said: “Before lockdown, just under 60% of children had visited an NHS dentist in the 12 months to December 2019. The 1st lockdown when dentists were closed and subsequent constraints on activity has resulted in a dramatic collapse in child visits to their NHS dentist. “The fear is that dentists will now have their work cut out dealing with tooth decay among children and I know that many dentists have already raised their concerns about the future of children’s oral health. I would call on the Government to focus on addressing the backlog of oral healthcare for children as a priority in the year ahead. We need to take action now to prevent this unmet need translating into more hospital operations than ever to remove children’s teeth.”

The latest NHS dental statistics are available here.

NHS reforms set to deliver on BSPD’s key campaigning aims

The government’s plan to reform the NHS has been welcomed by BSPD which believes that joined-up care in the interests of children is now on the horizon. Claire Stevens, BSPD’s spokesperson, says the proposed legislation set out in the White Paper has the potential to make a significant difference to children’s oral health.

“There are three reforms which are most relevant to paediatric dentistry – reducing barriers to community water fluoridation, a reduction in advertising of high sugar products and an emphasis on joined up care.”

Claire said: “ BSPD supports water fluoridation as a highly effective measure for preventing dental disease. Only 10% of the UK has access to fluoridated water yet this public health measure can reduce general anaesthetics for the extractions of decayed teeth in young children by as much as 68% in the most deprived areas. “

“For some time BSPD has been pressing for improved food labelling and for a restriction on the advertising of products high in fat, sugar and salt (HFSS). According to the plans, the government will proceed with both, which we welcome.”

Claire continued: “Once enacted, the proposed new legislation should ensure that dental leaders  are working collaboratively with medical, public health and commissioning teams to make decisions about health provision in the best interests of their local population.”

Nationally, Claire is already briefing medical leads on dental issues. “They are beginning to understand that good oral health is critical to the overall health and wellbeing of young patients. Paediatric dentistry is recognised as a national priority and this will allow us to work with the developing Integrated Care Systems to reduce the unacceptably long waiting times for dental treatment under general anaesthesia. 

“A perfect example of greater integration would be that services recognise the links between obesity and caries and collaborate so children who are at risk of both get the care and support they need. This is already happening in some places but needs to be developed.”

She added: “There is a long way to go but I have genuine hope that we are on the cusp of significant and positive change.”

BSPD’s position statements on water fluoridation and dental caries and obesity can be found here: https://www.bspd.co.uk/Professionals/Resources/Position-Statements