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NHS Dentistry Implementing the new contractual arrangements


Understand Patient's Charges risk. Reform of NHS Dentistry ... Contract and regulations surgery. NHS Dentistry Implementing the new contractual arrangements ... – PowerPoint PPT presentation

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Title: NHS Dentistry Implementing the new contractual arrangements

NHS Dentistry Implementing the new contractual
  • A Learning Event for PCTs and SHAs

Welcome and Introduction
Welcome and Introduction
  • Housekeeping announcements
  • Timetable for change
  • Recognise pressures on PCTs and SHAs
  • DH Guidance and PCC support to PCTs
  • Opportunity to hear about key issues for
    implementation programme locally
  • And more interactive work on concerns and
    pressures in breakout sessions

Reform of NHS Dentistry

Reform of NHS Dentistry (1) Local commissioning,
national framework
From April 2006, PCTs responsible for
commissioning primary care dental services
within national framework of
New system of patient charges
3-year investment guarantee
Contract regulations (GDS PDS)
NICE guidelines (recall intervals)
Oral health plan, including fluoridation
Devolution of budgets to PCTs from April 2006,
based on historic GDS spend 250m net investment

Reform of NHS Dentistry (2) Overall objectives
How local commissioning helps, both in the
short term
Stabilise investment at PCT level
Sustain dentists commitment to NHS (off the
treadmill 3-year income guarantee)
Promote less intervention more preventive
Facilitate access improvements (NICE guidelines)
and by establishing a platform for
Influence over where new practices establish
Stronger local relationship with NHS dentists
Commissioning to meet oral health needs of
Commissioning to further improve access
Reform of NHS Dentistry (3)
  • 10 key actions from guidance
  • Named PCT leads and contact points
  • Engage with dentists and patients groups
  • Use information from DPB to agree appropriate
    activity levels
  • Benefit from model contracts
  • Understand Patients Charges risk

Reform of NHS Dentistry (4)
  • 10 key actions from guidance cont.
  • Make contract offers early and agree by end
    February 2006
  • Request support if problems emerge
  • Agree out-of-hours/unscheduled care service
  • SHA wide approach to commissioning specialised
  • Develop new Performers List by April 2006

Reform of NHS Dentistry (4)
  • NHS performance framework (in development)
  • PCT leads (current and new)
  • Dental activity expectations (UDA and
  • non UDA)
  • Forward planning

Reform of NHS Dentistry (5)
  • Units of Dental Activity (UDAs)
  • Key measure reflects 5 reduction in activity
    reduction in treatment within bands
  • UDA total at PCT level is a reflection of total
    stability/growth/vfm in dentistry
  • to UDA ratio will vary as a result
  • Will begin to vary in future according to
    commissioning decisions eg high need groups

Contracting (1) Timetable
  • Legislative process due to be completed by end
    November 2005 (patient charges)
  • Information to be sent out by end November
  • Charge Regulations (subject to Parliament)
  • Finalised nGDS nPDS contracts Regulations
  • Budgets
  • Model Contract
  • Statement of Financial Entitlement
  • Transitional Order

Contracting (2)
  • Formal contract negotiations from December
  • Contracts can be signed from 1 January 2006
  • Aim to have contracts signed by 28 February (to
    enable DPB to process information by end March)

Contracting (3) Key Changes to Regs
  • Normal surgery hours replaces core hours
  • Death in Service
  • Irrevocable breakdown of relationship
  • Completion of Treatment

Contracting (4) Children and Exempt Patients
  • PCTs may agree children or exempt only contracts
    if appropriate
  • Practices may NOT use parents signing up
    privately as a prerequisite for child registration

Contracting (5) Performers List
  • Primary dental services only to be provided by
    persons on performers list
  • Requirement from 1 April 2006
  • Current dentists transfer to new single list
  • Only need to be on one list
  • CRB Checks

Contracting (6)
  • There is NO default contract
  • no contract in place no NHS work

Dispute resolution
Contracting (7) nPDS / nGDS
  • nGDS
  • Must contain all mandatory services
  • Not time limited
  • nPDS
  • Time limited
  • Specialist services
  • Available to practices working under existing
    pilot arrangements
  • If contains mandatory services cannot pick and mix

Contracting (8) Key Points nGDS
  • Information sent to providers and PCT - by
    individual contract provider
  • Contractors are entitled to an individual
  • PCTs may enter into practice based contracts with
    the agreement of all parties
  • Emphasis should be on agreeing like for like
    contracts based on reference period
  • Can include undertaking about future discussions

Contracting (9) Key Points nPDS
  • Information to PCTs by individual contract
  • PDS reference period activity converted to UDAs
    forms basis for contract activity
  • Current PDS pilots can agree a substantive nPDS
  • or nGDS contract
  • If moving to nPDS
  • new contract duration should be at least
    unexpired part of the pilot
  • value must be at least the value of the pilot
  • negotiate UDA values
  • If moving to nGDS
  • entitled to contract value
  • negotiate UDA values - could be agreed based on
    local nGDS levels

Contracting (10) Activity
  • For nGDS, CACV UDAs in reference period less 5
    to allow dentists to get off IoS treadmill
  • For existing PDS pilot practices, activity levels
    should allow practices to work in new ways and
    achieve PCR
  • Flexibility to include non-UDA activity in
    contract BUT cannot assign UDAs to that activity
  • Any non-UDA activity must be clearly defined in
    the contract and should include appropriate

Contracting (11) Out of Hours
  • PCTs responsible for all residents visitors
  • Key national principles
  • Dental OOH services may be integrated with
    medical OOH services
  • Triage (form is up to PCTs)
  • Patient should have access to telephone advice,
    and face to face contact when appropriate
  • Genuine dental emergencies are rare, so
  • OOH advice can be provided for a large area by
    telephone triage a dentist on call with access
    to facilities
  • OOH service is not a substitute for urgent

Contracting (12) New practices
  • Practices setting up without complete 12 month
  • are entitled to contract if in practice on 31
    March 2006, but
  • Negotiate full year value level of service to
    be provided
  • Can base additional activity on local needs
  • Funding for any additional activity comes from
    PCT 2006/7 budget
  • Dentists moving to a new practice
  • Within PCT
  • Outside PCT

Contracting (13) Handling Change
  • Turnover
  • Retirements, workforce mobility
  • Practices leaving NHS
  • Reduced NHS commitment
  • Funds remain within PCT budget
  • Ensure continuity of patient service
  • PCT (quick) interim response

Opportunity to reconfigure services in line with
local plan and priorities
Finance and Activity
Finance and Activity (1) Overview
Current gross NHS income
Uprated by 06/07 prices
Calculated Annual Contract Value (CACV)
Current activity (item of service)
Weighted courses of treatment (units of dental
activity) less 5
Activity to be delivered in return for CACV
Indicative comparison of GDS/PDS using new
currency of weighted activity
Former GDS activity
PCT uses as basis for re-setting PDS agreements

New PDS activity
Charge income under GDS
New charging system (Bands 1, 2, 3) reduction
in activity
Designed to deliver same level of income in future
Finance and Activity (2)
National resources earmarked by PCT
  • 2004/05
  • 2005/06
  • 2006/07
  • 2007/09
  • verification in progress
  • budgets produced
  • RLA / CLA imminent
  • RLA / CLA adjustments Jan 2006
  • growth and handling imminent
  • budgets issued end November 2005
  • PCT Budgets reset each year

Finance and Activity (3)
  • PDS pilots approved and live will be funded
  • but
  • gt3 months will only be funded exceptionally
    (where good reasons for delay)
  • lt3 months will only be funded with an agreed go
    live date
  • PCT variations above approved sums not funded
    within devolved budget

Finance and Activity (4)
  • Patient Charges Revenue
  • 2005/06 risk covered up to 20
  • Risk above 20 needs PCT justification to SHA
    then recommendation to DH
  • 2006/07 PCR risk if UDAs are delivered then
    normally PCR will be delivered

Finance and Activity (5)
  • Business rates - direct reimbursement
  • Seniority payments - for dentists transferring
    from GDS
  • Employers superannuation included in the
    allocation but is not part of the CACV
  • Maternity / paternity leave long term sickness
    funded from allocation
  • VT Funding arrangements to be facilitated by
    SHAs and distributed in accordance to location of
  • CPD / Clinical Audit included within CACV

Commissioning (1) specialist services
  • Key areas covered
  • Specialist commissioning
  • Orthodontic contract currency
  • General lessons

Commissioning (2) Specialist services
  • PCTs will be expected to commission specialist as
    well as general services from April 2006
  • Most common specialist services include
    orthodontics minor oral surgery (info on
    sedation domiciliary care)
  • Those accessing services often come from wide
    geographical area
  • Funding within baseline of where service based

Commissioning (3) Specialist services
  • Need to
  • Determine patients flows
  • ensure that PCTs work together across SHA and SHA
  • Local commissioning plans set priorities assess
    need for specialist services

Commissioning (4) Specialist services
  • Information being made available to PCTs
  • Specialist practitioners
  • Dentists limited to orthodontics - activity
    income translated into Units of Orthodontic
    Activity - transfer into nPDS
  • Mixed practices
  • Orthodontic activity summary - activity income
    - agree future UOA
  • Number of domiciliary visits (cost per case)
  • Number of sedations provided (cost per case)
  • Transfer into nGDS (with addendum)

Commissioning (5) Number of Orthodontic Claims
by Year
Commissioning (6) Fees authorised for
orthodontic treatment ( millions)
Commissioning (7) Orthodontic treatment (Item
32) as a proportion of total item of service fees
  • 1991/1992
  • GDS expenditure 1,041,289,918
  • Orthodontic treatment 30,692,000
  • 2.95
  • 2004/2005
  • GDS expenditure 1,228,917,668
  • Orthodontic treatment 146,354,413
  • 11.91

Commissioning (8) of principal dentists by no
of orthodontic appliance claims 2004-2005
Commissioning (9) Orthodontic trend
  • Proportion of GDS expenditure risen significantly
    now 12
  • But - 72 of dentists provide no orthodontic
  • 19 provide lt10 appliances per year
  • Move to more specialist activity
  • Rise in orthodontic activity may account for GDS
    growth in some areas

Commissioning (10) Orthodontic services
  • Planning - 30 of 12 year olds as initial guide
    (DPH Consultants) patient flows
  • Contracting currency based on the provision of
    annual number of Units of Orthodontic Activity
    (UOAs) - 2 main activities
  • Case assessment 1 UOA
  • Case start 20 UOA (included all necessary
  • treatment)
  • Proportion of case assessments versus starts
    depends on local circumstances

Commissioning (11) Orthodontic services
  • Index of Treatment Need (IOTN)
  • 3 with an aesthetic component of 6
  • 4 and 5
  • 14 of current activity falls outside these
  • Commissioning for population under 18 at the time
    of assessment
  • Adults - by negotiation (currently 2.2)

Commissioning (12) Orthodontic services
  • Dentists with a Special Interest (DwSI)
  • PCTs should ensure
  • Dentists have the skills for accurate diagnosis
    treatment planning, or
  • Mechanisms for diagnostic treatment planning
    element (or verified) by specialist or hospital
  • Continued level of competency in orthodontics

Commissioning (13) Orthodontics services
  • When practitioner transfers into new contracting
  • arrangement, all incomplete GDS courses of
  • treatment will be paid by DPB at
  • 70 of total fees for ongoing treatment (less any
    interim payments made)
  • 50 for incomplete supervised retention
  • Fees paid under practitioners GDS schedules -
    not be include as part of the nPDS/GDS contract
  • Performance monitoring - outcome measure Peer
    Assessment Rating (PAR) Index (min 10 cases to

Commissioning (14) Lessons learned
  • PCTs need to access expertise
  • Local plans need to set relative priorities
  • Growing specialties in primary care look at
    secondary care context
  • Be clear about activity

Commissioning (15) Lessons learned
  • Do not leave initiative and expertise to the
  • Then providers will respond to vfm requirements
  • Changing UOA value in response to active

Working with dentists
Working with Dentists (1)
  • What worries dentists and how to reassure them
  • Myths and misconceptions and how to dispel them
  • Loss of autonomy
  • Back on the treadmill
  • Mixing private and NHS

Working with Dentists (2)
  • Working with LDCs
  • BDA document
  • Building on PDS
  • Role of DROs and dental advisors

Breakout Sessions (1)
  • Each session twice 1 hour long
  • Facilitators will record key points
  • Format
  • Short presentation (focus on current local issues
    pragmatic ways forward)
  • Discussion groups (issues ways forward)
  • Report back from groups discussion/reaction
    from presenters

Breakout Sessions (2)
  • Working with dentists and LDCs
  • Contingency Planning
  • Agreeing Contracts and Activity
  • Specialist contracting including Orthodontics
  • DPB information for contracting
  • Contract and regulations surgery

NHS Dentistry Implementing the new contractual
  • A Learning Event for PCTs and SHAs
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