Memorandum by Mrs H Diane Martin (DS 03)
I welcome your inquiry into NHS dental and orthodontic
services, because I feel very demoralised by the current state
of affairs. I qualified in 1981 and I have always worked in general
practice providing care for NHS patients. Until this new contract
was imposed I had considered my work to be appreciated and well
rewarded. Now I feel there are major problems with the service
and the remuneration.
The reforms were sold to us as a means of improving
work balance by removing the "treadmill" of piece work,
and to improve our ability to practice preventive dentistry, ie;
advising to improve dental health rather than just treating disease.
As far as I am concerned the connection between "work done"
and "pay earned" is just as close yet not as fair, and
there is a negative incentive to practice preventive dentistry.
1. Under the old contract some dentists provided
large volumes of complex work attracting huge gross payments which
translated to 12 UDA's per course. Under the new contract they
were allocated the same gross but can now provide just one crown
per course and easily achieve their target UDA's. And more annoyingly
they now have a reduced laboratory bill and thus are earning more
money for doing less work. Why did no-one think to make laboratory
bills part of the equation?
2. We were told how many UDA's we were to
provide for the same gross earned the previous year, yet there
was no way we could check if that figure was correct. Now we are
striving to achieve a target which is totally unrealistic, and
for which the goals keep changing. Our interpretation of the rules
differs from those of the PCT and the Practice Board in Eastbourne.
We do not know how the Bands were allocated historically, whether
the difference between Band 2 and 4 could be applied accurately
by someone looking at old claims, not knowing the circumstances
under which the patient attended on each individual visit. Over
a year the accumulated score can alter considerably if more courses
were allocated as Band 2 rather than as Band 4. Now we are committed
to achieving an inflated target.
3. I feel the target is also inflated because
under the old contract we were able to make a separate claim for
each child we saw who required an orthodontic examination. Thus
our historical gross included this value but now under the new
contract there is no possible way to earn the equivalent UDA value,
so to make-up for this discrepancy we have to squeeze more patients
into the time available.
4. Achieving Band 3 for most regular patients
is quite easy but they are subsidising those patients who have
neglected their teeth. If a patient needs a number of fillings
we have to try and squeeze as much treatment as possible into
each visit, as each visit after the first means no UDA's are being
earned for that time. Doing a lot of work in one visit is not
ideal. Historically treatment could be split, for example extracting
a tooth, waiting for healing then adding onto a denture. This
would have given two Band 3 courses, however now the patient pays
for a Band rather than for the actual treatment we have to hold
the first course open and only gain one Band 3 for the same work
undertaken. Again making it harder to achieve targets.
5. There is a considerable problem with patients
not keeping appointments. Under the old system we were able to
make a charge, this helped encourage patients to attend and made
up for loss of earnings. Now we are told there is no loss of earnings
as a result of a patient failing to attend, but there is a potential
for claw back at the end of the year if targets are not met. It
is impossible to make-up lost time in a day, once an appointment
is not used it is wasted time. A no show means no UDA and reduced
6. I have had to reduce my target of UDA's
( hence my gross) to make the target reasonable, or rather to
make my daily workload manageable. I have to earn 25 UDA's per
day, this doesn't sound a lot about 4/hour. But if most patients
are in the middle of a course on some days my total could be as
little as 8, so I have to make the rest up on other days. The
pressure is immense. I can afford to give a patient just 15 minutes
for a full examination, scale and give advice. Where is the time
Mrs H Diane Martin
12 November 2007