Nigel Hawkes, Health Editor
Download 'Too Hot', an exclusive Specials track from iTunes
Dentists may have to pay back millions of pounds to the NHS because they have failed to reach their targets in the first year of a new contract.
Some dentists face repayments of tens of thousands of pounds, and in a few cases more than £100,000. The impact on dental practices will be even greater because their income next year will be reduced, and it is feared that the problems may lead to even more dentists leaving the NHS.
The problem is the latest to hit the troubled NHS dental contract, which rewards dentists for the “units of dental activity” (UDAs) that they complete. Many dentists – nobody yet knows how many – have failed to achieve the UDA targets that were set by primary care trusts, and for which they have already been paid.
One dentist said that the contract had turned him into “a UDA factory”, working flat-out to achieve the targets. Others said that the only way to reach the targets was to take on quick jobs such as extracting teeth, rather than root-canal surgery to save the tooth, which earns the same UDA score.
A survey by the British Dental Association (BDA) found that 61 per cent of practices expected to miss their targets. There are about 20,000 NHS dentists, so as many as 12,000 could face financial penalties. In practice the number is likely to be smaller, because as long as a dentist achieves 96 per cent or more of the target, the money owing can be paid off in the next year.
The BDA fgures are backed by a smaller survey by Denplan, a company that provides dental payment plans. This found that 53 per cent of the 122 dentists that it approached expected to miss their targets by enough for their PCTs to insist on “clawing back” money, and that they would receive a smaller contract next year. Another 13 per cent said that they expected to be asked to return money, but to be given the same contract.
At least one dentist who spoke to Denplan said that he had been served a “notice of intent” by his PCT to reclaim £100,000 for underdelivered UDAs. The dentist was still in negotiations with the PCT over the amount.
Susie Sanderson, chairman of the BDA executive board, said that the final figures would not be collated until the end of June. “It throws a real threat on the viability of many practices,” she said. “Dentists own their practices and have to invest very heavily in them. They need a high standard of equipment, and good training for their staff. They’ve invested the money in the practice, and they are pretty resentful.” Stephen Gates, managing director of Denplan, said: “Many dentists are beginning to think very carefully about their future. They have looked at the contract and said, ‘We can’t run a business on this basis’.”
David McBride, a dentist in Norfolk, said that he knew dentists who had not managed well under the new system. “Perhaps I shouldn’t say this,” he said, “but I think if you haven’t done the work, you shouldn’t be paid for it.” He agreed, however, that the UDA system was defective. “If a patient comes in and needs more than two crowns, it costs me more to do the work than I get paid,” he said. “So there is a temptation not to do things that need doing. There is a huge potential for supervised neglect.”
The BDA has told the Government that alternative ways of monitoring dental contracts must be found. “UDAs are fundamentally unfit for purpose,” Lester Ellman, chairman of the BDA general dental practice committee, said in a letter to the chief dental officer for England, Barry Cockroft.
A spokeswoman for the Department of Health said: “Practices have up to two months after the end of the year to finish reporting courses of treatment, so PCTs and practices will not yet know the final position. But if a practice has not carried out the agreed level of patient care, the PCT will have to discuss why this has happened and, if appropriate, adjust the amount paid to the practice to reflect the level of service delivered."
Big business
50% Amount of average dentist’s income from private work. Fifteen years ago it was 6%
20,887 Number of NHS dentists at end of 2006. On March 31 last year it was 21,111
£100,000 Estimated income of one in ten dentists before the new contract system
46% Percentage of adults registered with a dentist (children 62.9%)
Source: Times database
Win a luxury weekend to Newcastle and its neighbour Gateshead, find out more here
Risk, resilience and embracing new technology
Industry sectors news at a glance. Interactive heatmap, video and podcast
Discover the power of collective thinking. Submit a solution and be in with a chance to win a Media Hub Home Entertainment System
The inside track on current trends in the charity, not for profit and social enterprise sectors
Everything the Business Traveller needs to know to make a better trip
Make the most of the summer and enter our fabulous photographic competition, you could win a £5000 holiday
Corsica is an island of beauty and contrast, an ideal holiday destination
Enjoy further reading from Travel to Fashion, Business to Sport, discover more
Shortcuts to help you find sections and articles
The clever way to lease a new car is with Car leasing made simple™
2009
per month on 36-month
Personal Contract Hire (PCH)
2008
42850
Car Insurance
£24,250 - £30,346
MI5
London
£60,000
The Environment Agency
Bristol
Up to £90K
Boots
Midlands
OTE £85k
Credit Protection Association
Nationwide Opportunities
Completely London
Luxury Condo's in Manhattan with NYC views
The best new homes in Wimbledon?
Nationwide
Fabulous Cruise And Cruise & Stay Offers Including Virgin Atlantic Flights Prices Start From Only £699pp!
Last Minute Cruise And Cruise & Stay Offers. Med From £499pp, Caribbean From £699pp!
5 star quality at a 3 star price.
8 fabulous Canadian cities ...you won’t find cheaper
Contact our advertising team for advertising and sponsorship in Times Online, The Times and The Sunday Times, or place your advertisement.
Times Online Services: Dating | Jobs | Property Search | Used Cars | Holidays | Births, Marriages, Deaths | Subscriptions | E-paper
News International associated websites: Globrix Property Search | Property Finder | Milkround
Copyright 2009 Times Newspapers Ltd.
This service is provided on Times Newspapers' standard Terms and Conditions. Please read our Privacy Policy.To inquire about a licence to reproduce material from Times Online, The Times or The Sunday Times, click here.This website is published by a member of the News International Group. News International Limited, 1 Virginia St, London E98 1XY, is the holding company for the News International group and is registered in England No 81701. VAT number GB 243 8054 69.
Having many friends working in nhs dentistry as well as providing private treatment i can say they feel nhs treatment is 'acceptable' however appropriate funding for treatment done by dentists is lacking, especially affecting newly qualified dentists who have seen a major drop in their overall salaries compared to previous dentists providing the same quantity of NHS work, and the variety of treatment they can provide is also less due to the pay structure
pp, manchester uk,
My husband is an NHS dentist and he drives a Ford Ka. The salaries quoted of 100K are misleading. My husband has to pay 50% of his earnings to the owner of the practice to cover overheads, nurses, receptionists etc. He then also has his lab fees deducted, dental insurance and regsistration with the GDC. Reality is that he earns nearer 35K than 100K. We have 2 children and I am going to have to return to work as we cannot make ends meet. He has now got a new job in the private sector. The main incentive was not financial, instead he wants to be able to provide high quality care which is impossible under the current NHS contract. The only way to meet UDA targets is to churn out shoddy work and my husband is not prepared to do that. I am amazed that there are any NHS dentists left.
A M
Somerset
Amanda Moores, Templecombe, Somerset
why is the car a dentist drives relevant? would people feel better if their dentist drove a seven year-old fiat panda? (no offence fiat) If the dentist does a good job then i would be happy or him/her to drive whatever car thay please
michael, fleetwood,
£100,000 per year, I'm 55yrs old with a 2:1 in Mechanical engineering, I earn a quarter of that. I've worked in manufacturing all my life paid full tax and NI (are dentists and doctors on PAYE you can bet your life there not)
I live in south liverpool where the majority of dentists have gone private. I was quoted £19.95 per month by Denplan.
that was two years ago. I've registered with two dentists since (the first went private within 6 months)
Interesting that when I was with the first dentist I was advised to come to the hygienist 3 times a year. I had a checkup at my current NHS dentist when I registered, I fully expected a clean however was told it was not necessary. Thats one year and counting since my last clean, mind you I still payed the £15.50 for a 7minute check.
The last time I had any dental work other than a cleanup was over 4 years ago. £240 for a years Denplan cover BDA Denplan and dentists are having a laugh.
Chris Brown, Liverpool,
Bry Barnes does not deserve to have a local NHS dentist. No doubt when the local dentist has finally downgraded to a Lada and been forced to go private he will be happy. The only real problem with the old contract was the money. So the Labour government changed everything except the money. The government should have provided a properly funded service for those in exempt categories. Instead, for ideological reasons, they insist on a third world service for everyone. The government did to dentists what they would have liked to have done to GPs. For example, when a dentist sells his business, built up over years of loyal service to the NHS, s(he) used to be able to sell the goodwill. Now the government has effectively stolen that goodwill and can transfer it to the lowest bidder. Fair?
Ian , London, UK
I am a registered dental hygienist in the US but have lived in the UK for over 12 years (and yes, I do pay taxes and NI). I am appalled at the standard of NHS dentistry. The dentists' hands are pretty much tied by the system and are often forced to provide care that is not in the best interest of the patient (i.e. pulling a tooth instead of doing a root canal and saving the tooth). I initially registered with an NHS dentist but was so appalled by the type of care I received (that was governed more by regulations than actual good dental practice) that I soon found a very good private dentist and joined a dental plan.
Lwaxana, London, UK
This really just shows what a lot of nonsense having a centrally-planned service always is, rather than having one paid directly by its customers. When dentists are wholly private they have to satisfy their individual customers to do well. Under the NHS they have to satisfy a lot of artificial measures and moving targets in a huge bureaucracy.
Whether it be dental work, medical consultation, or surgery, the NHS is vastly inferior to what is provided by the private sector. I know so many cases of friends, relatives and even myself coming close to death as a result of NHS incompetence. This latest debacle is one more reason for abolishing the NHS entirely. Some kind of state-funded insurance would be needed for the poor, but I am sure everyone could have much better care than is currently available to those who use the NHS.
Alan, London, England
The UDA system is such that it fails to take into account the variation in complexity of dental treatment provided. For example, a dentist would achieve the same UDA score for a patient requiring a single crown as a patient who requires 6 fillings, root canal treatment and one crown. Clearly, a greater volume of healthcare would have been provided for the latter patient, but there is no corresponding rise in UDA to show for it. How, therefore, can the UDA system reliably reflect the amount of healthcare dentists are actually providing in relation to meeting targets?
T L, Kent,
Oh dear!
Means my local NHS Dentist might have to get rid of one of their 2 brand new Porsche Boxters and might have to downgrade the new Range Rover Sport as well.
Hard times ahead indeed.
Bry Barnes, Somerset, Uk
Another "Target debacle" ruled over by this government! "Targets, targets, targets" should have been Blair's sound-bite when he came to government, not "education, education, education". This is why the NHS is not making headway when it has money pouring into it - there is a whole industry in government (and the NHS etc) just to set and measure targets.
B. Cox, cambridge, uk
GPs met the targets set by their new contract and saw their pay being cut in the form of a reduction in pension.
If dentists had hit their targets one wonders if the government would have clawed back the pay in other ways on the grounds of 'affordability'
john phillips, edinburgh,
I have found my NHS Dentist seriously substandard. On a recent visit to the US I visited a dentist to check a toothache I had. He found 6 cavities after taking x-rays and I said I would have them filled when I return to the UK. The first thing I did when I was in my dentists office in the UK was tell him I had 6 cavities, and with my x-rays in hand I figured he would see what the US doctor had seen. To my surprise, all he did was 'count' my uppers and lowers and tell me everything looked fine! No cavities! And this was without even bothering to look at the x-rays. I asked him how it was possible, since I was sure cavities do not disappear. His response was that my teeth were 'perfect' and no other work was necessary, not even a cleaning! In the future I will be going back to the US to have all my dental surgeries and cleaning, I am happy to pay to get the service I require, instead of hurried out of the door within 4 minutes to attend to his quota of clients!
Courtney, spalding, UK
Like everything else in this country - the Government interferes and it collapses. We spend millions of taxpayers money training these dentists. Why can't we just pay them a salary and let them treat those taxpayers? Why are we obsessed with targets and measurement? Will we have league tables of who pulled the most teeth next?
Steve, London, UK