Dentists lose funds for missing "unrealistic" treatment levels

FEARS were growing last night that more NHS dentists in the region could go private after failing to hit “unrealistic” targets.

FEARS were growing last night that more NHS dentists in the region could go private after failing to hit “unrealistic” targets.

Approximately half of the NHS dentists in Northumberland, North Tyneside and Newcastle have not met their targets during the first year of the controversial contract which was brought in during April 2006.

And around a third of NHS contracts in Sunderland, Gateshead and South Tyneside and County Durham have also missed the required government levels of activity.

They all now face having funding for patients clawed back.

The profession has criticised the target driven contract ever since it was brought in and many have turned their back on the NHS to go private, citing patient care as their main reason.

The problem is echoed nationally as 46% of dentists achieved less than 96% of their targets, according to the Department of Health after a Freedom of Information request was submitted by the British Dental Association (BDA).

Health bosses insist there is “flexibility” in the contract for dentists who have not hit their targets and any money taken back will be commissioned at other practices.

But chair of the North Tyne Local Dental Committee Jane Ainsworth said she was “flabbergasted” at the numbers for the North of Tyne region who had not achieved the 96% target.

“I am amazed as I didn’t think it would be as many as that.

“For those who have only hit 96% or less of their targets their funding will be clawed back.

“It could prove crippling for NHS dentists.”

The private dentist treats only children on the NHS at her Shiremoor practice and has received a letter from NHS North of Tyne to claw back around £8,000 of funding which must be repaid in installments over the next year.

“Although the Chief Dental Officer has said that the PCTs can be flexible about this and use their discretion, the local PCT has taken a hard line and said that everyone who has under-delivered will have the money clawed back.

“Dentists who also treat adults on the NHS may well go private and more may well leave the NHS. Many are afraid for the future of dentistry on the NHS,” she said.

Dentists have said the targets are challenging as the amount of time taken on a treatment is not reflected in the payment system.

A dentist is paid the same for fillings whether a patient needs one or 12 at any one time, giving concerns for high needs patients.

Money is not available under the contract to grow their services, instead they must wait until another practice goes private or closes.

The funding is capped for three years and if dentists don’t hit their target it is considered a breach of contract and their funding is clawed back.

North-East spokesman for the British Dental Association, Shiv Pabary, had warned previously that if the reduction in funding continued this financial year, surgeries would no longer be viable and may close.

Practices would have to downsize and wouldn’t be able to treat the same number of patients, and more dentists would leave the NHS, he predicted.

David Landes, dental lead for the region’s Strategic Health Authority, NHS North-East said: “It is up to the individual PCTs how funding is taken back. They will discuss this with their practices. They don’t want to destabilise the practices and would look at a way of minimising the impact on practices.

“It is taken back over a long period, usually a year.”

He said there had been large numbers of practices taking up capital grants for investment in their practices which showed they were committed to staying in the NHS.

A spokesperson for the Department of Health said 95% of contracted activity was delivered in 2006/07.

“Given this was the first year of the most fundamental changes to NHS dentistry since 1948 this was a very robust result.”

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Figures reveal an alarming picture

NUMBER of dentists who did not achieve their 96% annual target for annual Units of Dental Activity in the North-East for 2006/07.

NHS North of Tyne and Wear

In Newcastle PCT 18 out of 44 contracts failed.

In North Tyneside 13 out of 28 contracts failed.

In Northumberland 23 out of 47 failed.

There are three specialist orthodontic contracts North of Tyne and all three achieved greater than 100% of contracted UDAs.

An NHS North of Tyne spokeswoman said: “It is misleading to look at the number of dental practitioners achieving UDA contracts as this does not reflect the variation in contract volume each dentist has.

“Some dentists have negotiated NHS dental contracts with lower volume, in comparison others have negotiated a large contract.

“For example, the difference between some dentists with contracts with less than 1,000 UDAs per year and those dentists with contracts exceeding more than 50,000 UDAs per year. Some practices have exceeded their contract and some have not.”

NHS South of Tyne and Wear

In Sunderland PCT area 8 out of 33 dental contracts failed.

In Gateshead PCT 13 of 28 dental contracts failed.

In South Tyneside PCT 3 out of 15 dental contracts failed.

There is only one specialist orthodontic practice, which is located in Sunderland. This practice achieved 100% of their annual target.

A spokeswoman for NHS South of Tyne and Wear denied patient care was being affected by having their funding clawed back.

“For the 24 practices that under achieved by more than 4% the PCT has put in place a process to reclaim this funding.

“This will be used to commission additional activity from other providers across Tyne and Wear.”

NHS County Durham

In County Durham PCT 22 out of 68 dental contracts failed.

All specialist contracts delivered in full.

A spokeswoman for County Durham PCT said: “Delivery between 96% and 100% of the contracted activity is acceptable with the difference being delivered in the following financial year.

“The PCT has flexibility beyond that with regard to specific circumstances.”

A spokesman for the region’s Strategic Health Authority NHS North-East said: “Under nationally agreed contracts, dentists have to achieve a certain level of activity each year.

“They need to achieve this by + or -4% in order to retain the money they receive from primary care trusts at the beginning of each year for carrying out the agreed levels of activity.

“If dentists do not meet the set targets, primary care trusts have the option to ‘claw back’ funding to recommission services from different providers so that patients still have access to NHS dentists.”

If for example through sick leave, maternity leave or relocation, a dental practice does not hit the target, their PCT will discuss the issues and reach a resolution with them individually.

A practice may not achieve 96% one year, but might achieve a higher figure the following year thus making up the shortfall – this is allowed under the terms of the contract, according to the NHS North-East.

A dentist may terminate their contract and therefore not hit the target for that year – but if this happens, the funding could be reinvested and is therefore not lost and does not necessarily affect access to NHS services.

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