The current NHS contract system for private dentists, based on activity targets over preventative care, could be incentivizing cases of both negligence and breach of contract.
NHS dental procedures are often carried out by private dentists that have entered into contracts with the NHS. Certain groups, such as under 18’s and pregnant women, are entitled to these procedures for a significantly reduced fee, with the difference covered by the NHS.
The system by which these private dentists are paid has been a constant source of controversy. Remuneration used to be based on the exact procedure that was performed. This incentivized dentists to undertake extensive - and crucially expensive - dental procedures. This ‘drilling and filling’ culture led to a call for fundamental reform.
The call was answered in 2006 with the ‘Unit of Dental Activity’ (UDA) system, which sees dentists allocated a set target number of ‘units’ or UDAs. Each treatment that is done would be put in a band that is equivalent to a certain number of UDAs.
The problem with this system is twofold.
BREACH OF CONTRACT
Once a dentist reaches their activity target, they can no longer treat patients on the NHS contract. In theory they should then refer patients onto colleagues who still have UDAs. However, they circumvent this contractual term by neither informing patients of their rights to treatment nor referring patients on to another dentist. Instead there is a clear incentive to act in breach of contract and pressure patients to pay for dental treatment privately. Instead of paying £50.50 for a root canal, a patient will end up paying £400.00 privately. This is the same with dental hygienists. Patients may not know if they are entitled to hygienists on the NHS. Dentists can take advantage of this lack of knowledge to suggest private treatment that can cost in excess of £100.
A patient’s ‘worth’ to a dentist is assessed according to the procedure they require. As such, a patient that requires five root canal procedures is worth the same as one needing just one, whilst requiring 5 times the work. The system puts pressure on dentists to reduce the time they spend with patients to simply hit their units. This has led to patients not receiving appropriate dental plans, with procedures either not carried out appropriately or even carried out at all.
Dentists are also incentivized to not properly advise patients on their treatment options. The system groups similar dental procedures into the same bands. For instance, both root canals and tooth extractions are in band 2, and see a dentist receiving the same levels of remuneration. However, the latter takes a fifth of the time to perform. As such, when presented with a patient that is suffering from extensive tooth decay, a dentist will most likely always suggest a tooth extraction even if the tooth can be saved.
For more information on the which dental procedures are available on the NHS, visit www.nhs.uk/
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