The emperor’s new contract

January 30, 2015

The emperor's new contractSometimes I feel really old. I was in practise for twelve years before we had a ‘New Contract’ in 1990. Somehow we survived another 16 years before the next ‘New Contract’, now we are expecting another. So this is my New, New, New contract! Or is it?

This time, 90 per cent of the income will be derived through Band 1, Band 2 and Band 3 charging, with Band 1 being paid on a capitation basis. Activity in Bands 2 and 3 will be measured with UDAs.

Just when you thought you understood

There will be two prototypes running in trials of the contract. One in which only Band 3 UDAs will count towards contract activity, but activity will be apportioned at 55 per cent of contract; one in which both Bands 2 and 3 UDAs will count towards contract activity, but will be apportioned at 25 per cent of contract. Capitation, or Band 1 activity will make up the difference in both prototypes to 90 per cent of contract. We`ll come to the final 10 per cent in a moment.

Now, I’ve got a degree and am a member of Mensa (for real), but it’s taken me hours of reading to be able to precis the above figures. The ‘quick’ guide is 44 pages long; let’s hope your practice manager has a degree in economics!

The missing 10 per cent

The new innovation in this contract will be ‘Dental quality and outcomes framework’ (DQOF). Ten per cent of income will be driven by a financial adjustment, which will be applied based on a practice’s performance against the DQOF framework, for which up to 1000 points will be available. Key points in this will be a patient satisfaction questionnaire and how well a practice performs in preventative and treatment pathways.

These are further broken down and defined as covering five domains:

  • Clinical effectiveness
  • Best practice
  • Patient experience
  • Safety
  • Data quality

Finally…

According to Dentistry magazine, primary care dentistry will remain a commissioned system with agreed annual levels of service delivery and arrangements to recover money for under-delivery.

Some things won’t change; dentists’ expenses arrangements will remain the same. In particular, this will apply to laboratory fees, which remain the responsibility of the dentist to fund out of gross remuneration. All practices holding a contract (not just the exiting pilots) may express an interest in becoming a prototype.

The first prototypes will be set up this year and, if they are successful, then more may be added in 2017/18 and 2018/19, which is the ‘earliest date at which a reformed contract could become the prevalent approach’.

John Shapter
John Shapter

Dental Specialist

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