Specialist Dental Accountants for over 28 years - Call 020 8346 0391 

He (Mac) has helped me as my practice has expanded from single-handed to a six surgery/8 dentist practice.

To read full testimonial, click here.

N2 - First Reactions to the proposed new contract

There has been much speculation in this area as to how exactly this new system will work, whether it will actually benefit dentists and what its consequences will be.

Here, we summarize the main concerns raised by dentists:

1. The objective of the new contract (Providing better access to GDS dentistry and to take dentists off the treadmill of item of service) would not be achieved.

The reason being that dentists will be doing the same level of work as before, will be offered no more money and will also be sent analysis of work patterns every quarter, which will make them feel is to ensure that they’re not slacking.

2. Patient needs are not being addressed properly as there seems to be no incentive to work at weekends or do evening surgeries.

3. The NICE report on examination intervals is expected to suggest that most patients would need to be seen annually rather than biannually. The concern is that we would be expected to take on twice as many patients (assuming they wish to be seen), and new patients on the whole cost more to treat.

4. We feel helpless, stemming from the fact that we feel that the government wishes to lock us in to a limited, if not reduced, income over which we have little control, and also control our working conditions.

5. The proposal is philosophical and "Utopian" in nature.

6. Some parts of the proposal suggest that it has been written without taking sufficient input from dentists, an example being paragraph 61 of "Improving Working lives". The Government expects dentists "to have more flexibility and time for contact with patients." As most GDPs spend, on average, 80-90% of their working lives actually physically treating patients, one wonders how much more contact is expected of us.

7. The proposals appear to be lacking in detail, and the prescriptive element on which the contract is to be founded is yet to be published.

8. No details have been released about the system for patient charges.

9. It is not clear exactly what treatment is to be provided under the new contract. The stated intention is that methods and treatment patterns should change.

10. The major issue of the role and remuneration of associates is covered in 2 paragraphs. Associates who hold a GDS contract on 31 March 2005 are entitled to a new contract. The worry here is where that leaves practice owners. If an associate were to move and set up a new practice, the PCT could decide to let the contract go there rather than at the current practice. Additionally, practice owners worry that if an associate leaves, and cannot be replaced immediately, the PCT may choose to transfer the released funding to a location it considers to be a higher priority.

Associates worry that they may be directed into practices where the PCT perceives that they are needed.

If the practice does opt for a whole practice contract, the concern is that the Inland Revenue could view associates as employed rather than self-employed.

11. The Q&A section suggests that GDPs can continue to do a mixture of private and NHS work, but does not provide any clarification.

12. For those practitioners already established in the private sector, it is thought that the new contract has nothing to offer.

For those practitioners who are undecided, it is felt that there would need to be more incentives and a more assured future if they are to tip the balance towards an NHS commitment.

For those practitioners who are committed to the NHS, we feel that this could be an exciting journey, possibly involving new opportunities and a sense of greater security.

13. Certain treatments, under the present system, are not available under the NHS, such as indirect resin restorations. 21^st Century dentistry is focused on the preservation of sound tooth structure. Restoration bringing this about cost more to the dentist and the patient. According to the wording of the contract, prevention is advocated, so we should offer these to the patient. We are asked to provide such treatment, the fees of which were not included in the assessment. So we are not being paid for them under the new contract.

14. The contract states, "modern teaching advocates a minimal intervention approach…" so less activity is advocated by the government, but the monitoring of fees is based on activity. This means a decrease in activity means less payment!

15. The monitoring of fees is based on past activity. However the contract aims to "allow (the dentist) a more preventive approach to patient care…" Activity and preventive approach are mutually exclusive. At present carrying out fissure sealants is recorded under the present system. If we carry this out under the new system, this will also not be recorded and will be therefore be recorded as inactivity and cause unreasonable doubt as to the deservedness of the dentist’s fees. Also time spent on treatments like fissure sealants will not be paid for.

16. The contract states "Your NHS commitment will be expected to remain the same for the same income. "Commitment and "activity" are not synonymous, but the contract uses them as if they were. So, in maintaining the same level of activity, this will mean that we are maintaining the same level of commitment to the NHS.

Commitment to the NHS means we are prepared to carry out work under the NHS where the patient so desires. Under the new system, dentists will be penalized if the patient prefers, say, white fillings to amalgam. It is then, in actual fact, the patient who is not committed to the NHS.

17. The contract assumes that new patients to the practice will need a lot of work. This is illogical and could lead to over-prescription of dental work so as to maintain activity levels.

18. If we want to de-register a patient because he does not pay or is an undesirable character, it is no reflection of a lack of commitment to the NHS, but that is how it will be seen.

19. The Government’s aim seems to be Dentists registering more new NHS patients. However, the care of these new patients will be at the expense of existing ones. Hence, the new system is interested in "numbers" rather than "names".

For the framework proposals, click here

We take great pride in our service, and would be delighted to invite you for a free 1 hour, no obligation meeting at our comfortable offices. Simply call us  on 020 8346 0391 to arrange a mutually convenient time.

This web-site was last updated on 01/04/2008

Specialist Dental Accountants for over 27 years.

Copyright © 2003-2008 Mac Kotecha & Company. All rights Reserved. The information on this site is for general guidance only. It is essential to take professional advice on specific issues about their impact on any individual or entity. No liability can be accepted for any errors or omission or for any person acting or refraining from acting on the information provided on this site.

We can still help you if you're not a dentist. Please click here